封堵术治疗青年偏头痛合并卵圆孔未闭的疗效

目的 分析青年偏头痛患者行卵圆孔未闭（PFO）封堵术后的临床疗效。方法 采用回顾性分析研究,选取2021-01—2022-01于商丘市第一人民医院行PFO封堵术的126例青年偏头痛患者,通过与PFO封堵术前对比,随访观察术后3个月、6个月、12个月的临床疗效指标变化,包括偏头痛发作的频率和持续时间、头痛冲击试验（HIT-6）评分,以及视觉模拟量表（VAS）评分等,对比不同级别PFO患者介入封堵术后的缓解程度。结果 PFO闭合后的随访显示,术后偏头痛的平均每月发作频率、持续时间、HIT-6评分及VAS评分均显著降低（P<0.001）。在3个月的随访中,54例（42.9%）患者的头痛指数降低>60%;12个月随访期间,40例（31.7%）患者偏头痛完全缓解,100例（79.3%）患者的头痛指数降低>60%。结论 封堵术可使大部分合并PFO的青年偏头痛患者头痛症状和生活质量得到一定程度的改善,具有一定的临床指导意义。     

应用对比经颅多普勒技术评价偏头痛和卵圆孔未闭的关系

目的：观察门诊有先兆偏头痛（MA），无先兆偏头痛（M0）患者和无头痛人群中卵圆孔未闭（PFO）的发生率，以及产生中或大分流PFO的发生率。方法：经受试者同意后，随机抽取我院神经内科门诊从2006年3月至2007年3月就诊的MA患者38例（男14例，女24例），MO患者44例（男15例，女29例），无头痛对照24例（男10例，女14例）。以肘前静脉注射手振生理盐水作为造影剂，并结合Valsaval动作，行经颅多普勒（TCD）监测，诊断PFO并对分流量进行分级。结果：MA组与对照组比，具有PFO者占42％，高于对照组的20％；其中中分流或大分流者高于对照组，差异有统计学意义。MO组具有PFO者也高于对照组，但差异无统计学意义。结论：MA患者比无头痛人群存在较多的PFO，其巾出现中分流或大分流的显著增多。     

偏头痛与卵圆孔未闭封堵术

近年来,越来越多的研究支持卵圆孔未闭（patent foramen ovale,PFO）和偏头痛存在着相关性,尤其是先兆型偏头痛（migraine withaura,MA）。PFO的主要特点是会发生心脏的右向左分流（right to left shunt,RLS）,而经皮PFO封堵术现在已经相当成熟。现结合近年来的文献,综述PFO封堵术对MA的治疗作用。     

卵圆孔未闭解剖和检查技术的进展

正心源性脑梗死的常见原因包括心房颤动、瓣膜病、近期的心肌梗死、扩张型心肌病、病态窦房结综合征、卵圆孔未闭(patent foramen ovale,PFO)合并深静脉血栓等[1],相对而言,与PFO相关的脑梗死容易在临床实践中被人们所忽略,部分医生甚至对卵圆孔的解剖生理病理和检查技术等尚感到陌生。本文将就这一问题做简要的综述。     

应用M-模经颅多普勒超声技术评价头痛与卵圆孔未闭的关系

目的观察头痛、有先兆偏头痛(MA)、无先兆偏头痛(MO)患者卵圆孔未闭(PFO)的发生率,以及较大分流的发生率。方法头痛患者268例,其中MA组59例,MO组158例,其他类型头痛组51例,健康对照组75例。以肘前静脉注射激活的生理盐水作为造影剂,并结合Valsava动作,行M-模经颅多普勒超声(mpTCD)监测,诊断PFO并对分流量进行分级。安静状态时出现阳性结果则判断为永久型分流,Valsava动作后出现阳性结果则判断为功能型分流。注射生理盐水后20 s内微栓子信号超过30个判断为大量分流。结果全部头痛患者中PFO的发生率为44%,其中永久型分流53例,功能型分流43例。MA组存在分流的患者数显著多于对照组(P<0.001),也多于其他头痛组(P<0.01)。MO组存在分流的患者数高于对照组及其他头痛组,但未获得统计学差别(分别为P=0.054和P=0.3)。较大分流量在MA组、MO组、其他头痛组和对照组的发生率分别为37%、15%、8%、4%,MA组、MO组均显著高于对照组(分别为P<0.01和P<0.05)。结论有先兆偏头痛组患者存在较多PFO,而且偏头痛组较大分流量的患者较多。     

卵圆孔未闭与偏头痛关系的研究现状

近年来,越来越多研究表明,卵圆孔未闭（PFO）与偏头痛有着密切的关系。本文总结了PFO与偏头痛相关性研究、探讨两者之间可能存在的共同发病机制、评价了卵圆孔未闭封堵术及抗血小板药物治疗对偏头痛的影响,为治疗和预防伴有PFO的偏头痛患者提供有力的理论依据。     

卵圆孔未闭介入封堵术前后脑血流自动调节监测一例报道

<正>1病例介绍女性患者,49岁,因"间断头痛20余年,加重1个月余,左侧肢体活动不灵1 d"于2014年4月9日就诊我院门诊。长期慢性头痛病史,情绪变化、生活习惯改变易诱发,休息或自服"去痛片"后可缓解,否认头痛先兆症状。上述症状反复发作,近1个月余加重,表现为头痛频率增加,持续时间延长。1 d前于看电视起身时发现左侧肢体活动不灵,上肢持物不稳,手指精细活     

卵圆孔未闭与偏头痛关系的研究现状

近年来,越来越多研究表明,卵圆孔未闭（PFO）与偏头痛有着密切的关系。本文总结了PFO与偏头痛相关性研究、探讨两者之间可能存在的共同发病机制、评价了卵圆孔未闭封堵术及抗血小板药物治疗对偏头痛的影响,为治疗和预防伴有PFO的偏头痛患者提供有力的理论依据。     

封堵术对缺血性脑卒中合并卵圆孔未闭患者的近期安全性及疗效评价

目的研究封堵术对缺血性脑卒中合并卵圆孔未闭(PFO)患者的近期安全性及疗效。方法分析2016年6月至2018年9月于河北医科大学第二医院神经内科就诊、经胸超声心动图声学造影(cTTE)和经食道超声心动图(TEE)检查同时确诊PFO的缺血性脑卒中患者56例,根据患者分为PFO封堵手术组(n=34)和非手术组(n=22),收集患者的一般临床资料,随访手术后患者的并发症情况并比较两组患者的预后情况。结果手术组94.1%患者成功置入封堵器,术中及术后无严重并发症发生。平均随访时间(8.79±5.75)个月,结果显示,两组都没有出现死亡和再次住院等严重不良后果,手术组缺血性脑卒中复发患者比例(2.8%)显著低于非手术组(25%,P=0.034)。所有手术患者于术后6～12个月复查心脏彩超均未见封堵器移位、脱落、血栓形成,心房水平未见分流,复查心电图无房颤等心律失常发生。手术组偏头痛患者头痛影响测定-6(HIT-6)评分(39.33±5.10)显著低于非手术组(66.83±1.33),且与术前(67.22±1.56)相比显著降低(P0.05)。结论 PFO封堵术可作为缺血性脑卒中合并PFO患者,预防卒中再发及改善偏头痛症状的一种安全有效的治疗方案。     

卵圆孔未闭与偏头痛的相关性研究进展

偏头痛是一种慢性血管性疾病,多表现为单侧、搏动性、中重度头痛发作,常伴恶心呕吐、畏光畏声等,中年女性高发,由于其较高的致残性且发病机制不明,一直以来被业内研究者所关注,并提出了许多假说.近年研究提示,发现卵圆孔未闭在偏头痛患者中的存在率远远高于健康人群,两者之间存在一定的相关性,通过关闭未闭合的卵圆孔,部分偏头痛患者症...     

Migraine and Patent Foramen Ovale

Migraine is a widespread disorder with a large impact on society. Patent foramen ovale (PFO) is a common occurrence, affecting about 25 % of the population. Observational studies report PFO to be more prevalent in patients with migraine with aura, and patients with migraine with aura have a higher incidence of PFO. The only population-based study does not support this link. It is possible that an association exists between large-sized PFO and migraine. This association may explain how migraine with aura can be triggered. Numerous studies have reported improved migraine with PFO closure, but the only prospective placebo-controlled trial aimed at closure of PFO in patients with migraine with aura did not support this. At this time, evidence does not support the routine detection and closure of PFO in patients with migraine.     

卵圆孔未闭致青年缺血性卒中介入封堵治疗一例

<正>1病例介绍患者男性,34岁,因"左侧肢体无力伴言语不利2 d"于2014年10月27日入院。入院前2 d,患者饮酒后约19 h出现左侧上下肢无力,不能持物,不能行走,伴言语不利,且饮水呛咳,就诊于首都医科大学附属同仁医院予以输液治疗1 d(具体不详),于1 d前转入首都医科大学附属北京天坛医院急诊,行头颅计算机断层扫描(computed tomography,CT)检查示右侧额、颞、岛叶及基底节区梗死灶,为求进一步诊     

Power M-Mode Transcranial Doppler for Diagnosis of Patent Foramen Ovale and Assessing Transcatheter Closure

BACKGROUND AND PURPOSE: Transcatheter closure of patent foramen ovale (PFO) can benefit from a less invasive diagnostic method than transesophageal echocardiography (TEE). Thirty-three gate power m-mode transcranial Doppler (pmTCD) was evaluated for its accuracy in diagnosis of PFO and utility in evaluating residual intracardiac right-to-left shunt (RLS) following transcatheter closure. METHODS: The sensitivity of pmTCD and single-gate TCD (sgTCD) to detect contrast bubble emboli through RLS was compared during transcatheter PFO closure. During 100 preclosure diagnostic evaluations and in 81 postclosure assessments, embolic tracks on pmTCD were counted following intravenous contrast injections and were graded using a 6-level logarithmic scale. The accuracy of TEE and pmTCD was separately compared to PFO anatomical findings during transcatheter closures. RESULTS: There were significantly more microemboli detectable on pmTCD (322 +/- 166; 95% confidence interval [CI], 388-257) than on sgTCD (186 +/- 109; 95% CI, 229-143; P < .001). McNemar change tests suggest that the diagnostic capabilities of pmTCD and TEE for detecting PFO are comparable and correspond to the anatomical findings determined during cardiac catheterization (P = .69 and .45, respectively). During 6-month postclosure evaluation (mean = 185 days), 66% of the patients demonstrated successful closure without significant RLS (ie, grades 0, I, or II), and 34% were found to have incomplete closure with significant RLS (ie, grades III, IV, or V). CONCLUSIONS: pmTCD provides greater sensitivity to contrast bubble emboli than does sgTCD. Among candidates for transcatheter closure, pmTCD provides an improved noninvasive method for diagnosing PFO and evaluating transcatheter closure.     

Closure of Patent Foramen Ovale and Cryptogenic Stroke: Unresolved Issues

Purpose of Review

This review summarises the results of randomised trials comparing closure of patent foramen ovale (PFO) with antithrombotic therapy in patients with cryptogenic stroke.

Recent Findings

Initially, three randomised trials failed to show superiority of PFO closure over antithrombotic therapy in patients with cryptogenic stroke. Three recently performed trials and the prolongation of an earlier trial provided evidence that PFO closure in patients with cryptogenic stroke and an age range of 18–60 years is superior to stroke prevention with antiplatelet therapy. PFO closure was not superior to anticoagulation. Anticoagulation, however, has a higher long-term bleeding risk. PFO closure could result in atrial fibrillation (AF) in a small number of patients. In most patients, AF was transient in duration. Optimal patient selection requires future research.

Summary

In patients with cryptogenic stroke aged &lt;?60 years, PFO closure is superior to antiplatelet therapy in the prevention of recurrent stroke.

     

卵圆孔未闭与缺血性卒中

1卵圆孔未闭与隐源性卒中的关系胎儿时期,肺不能接受血流,返回到右心房的血液是通过开放的卵圆孔分流至左心房的。出生后,约75%的人卵圆孔自动关闭,而25%的人发生卵圆孔未闭(patent foramen ovale, PFO)。卵圆孔未闭不影响血流动力学,正常情况下,卵圆窝膜可阻挡左向右的分流,当右房压力升高时,卵圆孔重新开放,为奇异性栓塞(如矛盾性栓塞,反常性栓塞,paradoxical embolism)提供了一个管道。     

卵圆孔未闭相关性卒中的诊治研究进展

卵圆孔未闭(patent foramen ovale,PFO)与卒中发病有明显的关联.应利用卒中高风险PFO解剖学特征、卒中影像特征及反常栓塞风险量表等,经多科综合评估,选择患者最适合的治疗方案.多数现有研究及指南支持对于卒中高风险PFO患者,首选PFO封堵术加术后长期抗血小板治疗;单独抗凝治疗与单独抗血小板治疗在预防...