索田源,冯杰莉,陈少敏,徐昕晔,尚志,张承铎,汪宇鹏

• 1:北京大学第三医院心血管内科
• 2:北京大学第三医院心血管内科血管医学研究所血管稳态与重构全国重点实验室国家卫生健康委心血管分子生物学与调节肽重点实验室心血管受体研究北京市重点实验室

摘要(Abstract)：

目的 分析长隧道型卵圆孔未闭（PFO）患者接受导丝通过型经皮PFO封堵手术的安全性和疗效。方法 回顾性收集2021年5月至2025年2月在北京大学第三医院心血管内科接受导丝通过型PFO封堵治疗的356例患者。结合纳排标准，最终纳入63例长隧道型PFO患者（隧道长度≥8 mm）。收集所有患者的临床资料、手术信息及随访数据。将患者分为隧道长度8～10 mm(A组)和≥10 mm(B组)进行亚组分析。结果 63例长隧道型PFO患者的平均年龄为46.8岁，34例（57.6%）合并大量右向左分流（RLS）。手术成功率92.1%，无严重并发症。（1）7例脑卒中患者中位随访376 d，未复发或新发脑缺血事件。（2）47例偏头痛患者中37例得到了完整随访量表，21例同时具有量表和出院后复查经胸超声心动图右心声学造影（cTTE）结果。偏头痛患者封堵后的视觉模拟评分法（VAS）评分[（3.99±2.69）分比（7.49±1.84）分]、头痛影响测验-6(HIT-6)评分[（46.65±8.50）分比（64.08±7.58）分]均显著下降（均P<0.001）。26例（70.3%）患者症状明显缓解或完全缓解，平均每30日发作天数由15.3 d下降到6.8 d;34例（91.9%）患者HIT-6评分降幅≥6分；B组与A组患者相比，卵圆孔更宽[（1.74±0.65）mm比（1.37±0.32）mm,P=0.039]，术前VAS评分更高[（8.11±1.29）分比（6.90±2.11）分，P=0.042]；对21例cTTE结果提示残余分流等级与VAS评分、HIT-6评分呈正相关（均P<0.001）。（3）54例脑卒中、偏头痛患者中有27例具有完整的术前、术后cTTE结果，中位随访376 d时，患者残余分流水平显著下降，Ⅲ级分流的比例显著降低（均P<0.001）;Fisher精确检验提示A、B两组术后残余分流等级分布差异无统计学意义（P>0.05）。多因素分析显示，年龄是术后偏头痛缓解的独立预测因素（OR 0.89,95%CI 0.81～0.97,P=0.010）。结论 导丝通过型PFO封堵对长隧道型PFO患者具有较好的安全性和有效性，围手术期不良事件发生率较低，并能有效改善偏头痛患者的症状和分流情况。

关键词(KeyWords)： 卵圆孔未闭;导丝通过型经皮卵圆孔封堵术;长隧道型卵圆孔未闭;偏头痛

Abstract:

Keywords:

基金项目(Foundation): 北京市自然科学基金-大兴创新联合基金项目(L256016)

作者(Author): 索田源,冯杰莉,陈少敏,徐昕晔,尚志,张承铎,汪宇鹏

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