肖家旺,王琦光,庚靖松,张端珍,张坡,陈火元,孟立立,朱鲜阳

• 1:北部战区总医院全军心血管病研究所先心病内科

摘要(Abstract)：

目的探讨经导管封堵卵圆孔未闭(PFO)在偏头痛治疗中的临床疗效。方法选取2016年7月至2017年8月于北部战区总医院住院并接受经导管封堵PFO的46例偏头痛患者,术后常规复查超声心动图及心电图,并于术前及术后6个月、12个月进行头痛发作频率问卷、头痛影响测验-6(HIT-6)、偏头痛残疾程度评估问卷(MIDAS)、视觉模拟疼痛评分(VAS)。结果 46例患者中男18例(39.1%),年龄42.5(24.0,60.0)岁,偏头痛病程为10(2,40)年,先兆性偏头痛8例(17.4%),无先兆性偏头痛38例(82.6%);发作频率为(8.2±4.4)次/月,术前右心声学造影示10例(43.5%)为中量右向左分流(RLS),36例(56.5%)为大量RLS。与基线水平比较,术后6个月及12个月头痛发作频率、HIT-6评分、MIDAS评分、VAS评分均明显改善(均P<0.05)。术后6个月复查右心声学造影仅3例有少量RLS。术后12个月20例(43.5%)患者头痛完全缓解,17例(37.0%)显著缓解,5例(10.9%)缓解,4例(8.7%)无效,而先兆性偏头痛(87.5%)与无先兆偏头痛(92.1%)缓解率比较,差异无统计学意义(P=0.879)。围术期及术后12个月随访期间所有患者均未见血栓/空气栓塞、股动静脉瘘、心脏压塞、封堵器移位及脱落、严重心律失常等并发症发生。结论经导管封堵PFO安全性高,能有效缓解伴大量RLS的PFO患者偏头痛症状。

关键词(KeyWords)： 卵圆孔未闭;偏头痛;经导管封堵术;右心声学造影

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81370276)

作者(Author): 肖家旺,王琦光,庚靖松,张端珍,张坡,陈火元,孟立立,朱鲜阳

参考文献(References)：

• [1]Del Sette M,Angeli S,Leandri M,et al.Migraine with aura and right-to-left shunt on transcranial Doppler:a case-control study.Cerebrovasc Dis,1998,8(6):327-330.
• [2]李蒙,何秋.偏头痛与心脏右向左分流关系的临床研究进展.中风与神经疾病杂志,2017,34(9):859-861
• [3]王思博,刘亢丁,杨弋,等.中国偏头痛患者右向左分流阳性率及分流类型--一项全国多中心研究.中国卒中杂志,2018,13(3):251-256.
• [4]Wilmshurst PT,Nightingale S,Walsh KP,et al.Eff ect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons.Lancet,2000,356(9242):1648-1651.
• [5]Headache Classifi fi cation Committee of the International Headache Society(IHS).The international classifification of headache disorders,3rd edition(beta version).Cephalalgia,2013,33(9):629-808.
• [6]中华医学会心血管内科分会,中国医师协会心血管内科分会.卵圆孔未闭预防性封堵术中国专家共识.中国循环杂志,2017,32(3):209-214.
• [7]周志彬,于生元.偏头痛相关评价工具.中国疼痛医学杂志,2015,21(4):241-244.
• [8]张宏伟,沈群山.偏头痛伴卵圆孔未闭患者介入封堵疗效观察.中国介入心脏病学杂志,2018,26(11):627-631.
• [9]Dowson A,Mullen MJ,Peatfi eld R,et al.Migraine intervention with STARFlex technology(MIST)trial:a prospective,multicenter,double-blind,sham-controlled trial to evaluate the eff ectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache.Circulation,2008,117(11):1397-1404.
• [10]Mattle HP,Evers S,Hildick-Smith D,et al.Percutaneous closure of patent foramen ovale in migraine with aura,a randomized controlled trial.Eur Heart J,2016,37(26):2029-2036.
• [11]Tobis JM,Charles A,Silberstein SD,et al.Percutaneous closure of patent foramen ovale in patients with migraine:The PREMIUM Trial.J Am Coll Cardiol,2017,70(22):2766-2774.
• [12]程锦浩,朱鲜阳,王琦光,等.卵圆孔未闭封堵术治疗偏头痛的临床疗效观察.心脏杂志,2016,28(3):326-329.
• [13]Kheiri B,Abdalla A,Osman M,et al.Percutaneous closure of patent f oramen ovale in migraine:A meta-analysis of randomized clinical trials.JACC Cardiovasc Interv,2018,11(8):816-818.
• [14]李晓晴,马闻建,袁鹏,等.伴卵圆孔未闭的偏头痛患者经导管封堵术治疗的临床资料.中华神经科杂志,2018,51(1):45-48.
• [15]Tobis J.Management of patients with refractory migraine and PFO:Is MIST relevant?Catheter Cardiovasc Interv,2008,72(1):60-64.
• [16]Lipton RB,Goldstein J,Baggish JS,et al.Aspirin is effi cacious for treatment of acute migraine.Headache,2005,45(4):283-292.
• [17]Saver JL,Carroll JD,Thaler DE,et al.Long-term outcomes of patent foramen ovale closure or medical therapy after troke.N Engl JMed,2017,377(11):1022-1032.
• [18]Carrol JD,Saver JL,Thaler DE,et al.Closure of patent foramen ovale versus medical therapy after cryptogenic stroke.N Engl JMed,2013,368(12):1092-1100.