偏头痛患者行卵圆孔未闭封堵术后1年残余分流与疗效分析  

Analysis of Residual Shunt and Therapeutic Effect in Migraine Patients After One Year of Patent Foramen Ovale Closure

作　　者：季春影 黄朝旭[1] 李晶[1] 孟庆娜 周丽明[1] 蒲朝霞[1] JI Chunying;HUANG Zhaoxu;LI Jing;MENG Qingna;ZHOU Liming;PU Zhaoxia(Echocardiography Center,The Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第二医院心脏超声中心,杭州310000

出　　处：《中国循环杂志》2024年第9期883-888,共6页Chinese Circulation Journal

基　　金：健康浙江百万人群队列(K-20230085)。

摘　　要：目的:观察偏头痛患者行卵圆孔未闭(PFO)封堵术后1年残余分流及偏头痛发作改善情况。方法:回顾性选取2019年1月至2022年6月在浙江大学医学院附属第二医院因偏头痛行PFO封堵术的106例患者,根据术后1年经胸超声心动图声学造影(cTTE)随访结果,分为0级残余分流组(n=67)、Ⅰ级残余分流组(n=10)、Ⅱ级残余分流组(n=13)、Ⅲ级残余分流组(n=16),分析以上不同残余分流组的偏头痛发作情况。使用多因素Logistic回归分析研究PFO封堵术后残余分流的影响因素。结果:106例患者的平均年龄为(35.80±11.70)岁,其中女性83例(78.30%)。PFO封堵1年后,0~Ⅱ级残余分流组偏头痛月发作天数、每次发作持续时间、偏头痛评分均较术前明显减低(P均<0.05),但Ⅲ级分流组上述各指标均无明显变化(P均> 0.05)。0级分流组(58.21%)、Ⅰ级分流组(60.00%)、Ⅱ级分流组偏头痛(69.23%)完全缓解+明显缓解率均高于Ⅲ级分流组(18.75%),P=0.02。在术前cTTE静息相≥6个心动周期出现微泡的患者中,术后cTTE 0级分流的患者比例小于术前cTTE静息相0级分流患者及6个心动周期内出现微泡的患者(24.00%vs.83.87%vs.70.00%,P=0.04)。多因素Logistic回归分析提示,术前cTTE静息相≥6个心动周期出现微泡的患者术后出现残余分流的可能性高于术前c TTE静息相0级分流(OR=0.06,95%CI:0.02~0.23,P<0.01)及6个心动周期内出现微泡的患者(OR=0.14,95%CI:0.05~0.41,P<0.01)。结论:PFO封堵术后1年0~Ⅱ级残余分流患者偏头痛明显缓解,Ⅲ级残余分流患者偏头痛无明显缓解。术前cTTE静息相≥6个心动周期出现微泡的患者中术后残余分流的发生率高于静息相0级分流患者和6个心动周期内出现微泡的患者。Objectives:To observe the incidence of residual shunt post patent foramen ovale(PFO) closure and the effect of PFO closure in these migraine patients at one year after PFO.Methods:This retrospective study included patients who underwent PFO closure for migraine in the Second Affiliated Hospital Zhejiang University School of Medicine from January 2019 to June 2022,patients were divided into the grade 0 shunt group(n=67),the grade Ⅰ shunt group(n=10),the grade Ⅱ shunt group(n=13) and the grade Ⅲ shunt group(n=16) according to the results of contrast transthoracic echocardiography(cTTE) at 1 year after PFO closure.The incidence of postoperative migraine attacks among different groups of patients were compared.The risk factors of residual shunt after PFO closure were explored.Results:The mean age of enrolled 106 patients with migraine was(35.80 ± 11.70) years,of which 83 patients(78.30%) were female.One year after PFO closure,the migraine attack and rating scale were significantly decreased compared to baseline in the grade 0 shunt group,in the grade Ⅰ shunt group and in the grade Ⅱ shunt group(all P < 0.05),but not in the grade Ⅲ shunt group(P > 0.05).The rate of significant and complete migraine was significantly higher in the grade 0 shunt group(58.21%),in the grade Ⅰ shunt group(60.00%),in the grade Ⅱ shunt group(69.23%) as compared to the grade Ⅲ shunt group(18.75%,P=0.02) at one year after PFO.The rate of grade 0 shunt after PFO closure in patients with the microvesicles appearing in ≥6 cardiac cycles in resting state before operation was significantly lower than in patients with the microvesicles appearing within 6 cardiac cycles and no microvesicles in resting state(24.00% vs.83.87% vs.70.00%,P=0.04).Logistic multivariate regression analysis showed that patients with microvesicles appearing beyond 6 cardiac cycles in resting state were more likely to have residual shunts in postoperative cTTE compared to the patients with negative cTTE and microvesicles appearing within 6 cardiac cycles i

关 键 词：卵圆孔未闭封堵 残余分流 偏头痛 

分 类 号：R54[医药卫生—心血管疾病]