右心声学造影诊断卵圆孔未闭的护理因素分析

目的分析相关护理因素对右心声学造影诊断卵圆孔未闭(PFO)的影响。方法选取2018年7月至2019年12月因偏头痛行经胸超声心动图声学造影(cTTE)检查的患者300例,根据使用造影剂的类型随机分为A组(生理盐水8ml+1ml自体血+1ml空气)、B组(50%葡萄糖溶液9 ml+1 ml空气)和C组(生理盐水9 ml+1 ml空气)各100例。比较三组患者在特殊呼吸状态下和平静呼吸状态下RLS的检出例数,并进行半定量分级,观察三组患者使用造影剂前后生命体征情况。结果右心声学造影诊断卵圆孔未闭,特殊呼吸状态下RIS检出例数明显高于平静呼吸状态;特殊呼吸状态下RLS的检出例数两两比较,A组高于B组,B组高于C组,差异有统计学意义(P<0.05);≥Ⅱ级的RLS检出例数,A组高于B组,B组高于C组,差异有统计学意义(P<0.05);三组患者使用造影剂前后生命体征相关指标比较,差异无统计学意义(P>0.05)。结论通过护理相关因素辅助cTTE,减少人为因素操作误差,可以明显提高PFO诊断率,具有较高的临床实用价值。     

卵圆孔未闭与反常栓塞的相关性及其研究进展

查阅近几年来国内外对"卵圆孔未闭(PFO)与反常栓塞"相关性研究的资料,从定义、诊断、定量诊断及治疗等方面简述了PFO,分析了它导致反常栓塞的相关机制及其相关性。通过PFO伴卒中治疗上的对比研究分析封堵治疗与药物治疗的可行性。     

卵圆孔未闭并发缺血性脑卒中1例

缺血性卒中是引起中老年人致残率及致死率较高的疾病之一,而有近半数的缺血性卒中患者未找到明确的病因。近年来随着临床研究的不断深入,发现卵圆孔未闭导致的反常性栓塞与缺血性卒中有一定的相关性,是引起青年性卒中的主要原因之一。本文就我院收治     

卵圆孔未闭与偏头痛研究进展

正卵圆孔未闭(PFO)是一种常见的先天性心脏病,由房间隔发育异常所导致,健康人中20%~35%存在PFO。近年来许多研究发现,PFO的存在与偏头痛(MA)、脑卒中、反常性栓塞、潜水减压病、斜卧-低氧血症综合征、高海拔肺水肿等疾病的发生存在联系,因此引起临床广泛重视。本文主要针对PFO及相关性MA的相关研究进展及二者之间可能存在的因     

超声心动图联合右心声学造影在卵圆孔未闭诊断中的价值探讨

目的:探讨经食道超声心动图(transesophageal echocardiography,TEE)、右心声学造影(contrast transthoracic echocardiography,cTTE)在卵圆孔未闭(patent foramen ovale,PFO)诊断中的应用价值.方法:本研究选取2019年8月...     

卵圆孔封堵术治疗偏头痛合并右向左分流的临床研究

目的:评价卵圆孔封堵术治疗偏头痛合并右向左分流(RLS)的临床疗效及安全性。方法:偏头痛合并RLS患者114例随机分为手术组及对照组,各57例;手术组采用卵圆孔封堵术治疗,对照组采用常规药物治疗。观察治疗后1年2组HIT-6评分与评分差值;术后1月内与1年后并发症发生率;术后24 h与1年后残余分流及新发梗死灶情况。结果:治疗1年后,手术组HIT-6评分为(49.57±4.58)分,差值为(14.38±3.57)分;对照组HIT-6评分为(56.85±5.69)分,差值为(8.64±2.24)分,2组差异均有统计学意义(P0.05)。术后1月内发生并发症11例(19.30%),1年后并发症均消失。术后24 h大量残余分流患者8例(14.04%),1年后仅1例(1.92%)存在大量残余分流。治疗1年后,手术组患者7例出现新发梗死灶,对照组17例,2组差异有统计学意义(P0.05)。结论:卵圆孔封堵术可有效改善患者偏头疼症状,安全性高,并可降低脑卒中发病风险。     

实时右心声学造影对卵圆孔未闭偏头痛的诊断价值

目的探讨实时右心声学造影应用于卵圆孔未闭偏头痛临床诊断价值。方法选取2018年1月至2019年7月在广东三九脑科医院收治的83例不明原因偏头痛患者进行本次研究,指定同一名高年资、高职称超声检查医师对入选患者予以右心声学造影检查,并将所得结果与其手术或随访确诊结果对比后得出结论。结果83例不明原因偏头痛患者经手术或随访证实卵圆孔未闭所占比例为49.40%,右心声学造影检查阳性率为48.19%(P>0.05)。右心声学造影对卵圆孔未闭检查敏感性为95.12%、特异性为97.62%。结论应用右心声学造影诊断卵圆孔未闭偏头痛具有较高敏感性、特异性。     

偏头痛与卵圆孔未闭关系的研究

目的：探讨先兆性偏头痛、无先兆性偏头痛患者和正常人卵圆孔未闭（ PFO）发生率的差异。方法采用经颅多普勒超声（TCD）检测先兆性偏头痛组（29例）、无先兆偏头痛组（31例）和正常对照组（26名） PFO的发生率,比较各组差异。记录治疗前偏头痛患者的头痛频率、头痛发作日数和头痛程度等,并分析其与PFD分流量大小的相关性。结果先兆性偏头痛组、无先兆偏头痛组和正常对照组PFO发生率分别为72％、45％和31％,先兆偏头痛组PFO发生率较正常对照组高（ P＝0.008）,无先兆偏头痛组较正常对照组高,但比较差异尚无统计学意义（ P＝0.491）;PFO大小与头痛频率、头痛发作日数呈正相关（P均＜0.05）。结论先兆偏头痛患者的PFO发生率较高,提示此两种疾病可能有共同的病理学发病机制。     

经食管与经胸超声心动图造影诊断卵圆孔未闭及右向左分流

目的 对比经食管超声心动图造影（cTEE）与经胸超声心动图造影（cTTE）诊断卵圆孔未闭（PFO）及右向左分流（RLS）的价值。方法 回顾性分析117例因偏头痛或隐源性卒中就诊的患者,均依次接受TTE、cTTE、TEE及cTEE检查;比较cTTE与cTEE诊断PFO的敏感度、特异度及对RLS分级的差异,观察二者诊断价值。结果 TEE联合cTEE共检出89例（76.07%,89/117）PFO;TTE、cTTE、TEE及cTEE分别检出18例（20.22%,18/89）、80例（89.89%,80/89）、75例（84.27%,75/89）及88例（98.88%,88/89）。cTTE存在9例（10.11%,9/89）假阴性、7例（25.00%,7/28）假阳性;cTEE存在1例（1.12%,1/89）假阴性,无假阳性病例。cTEE诊断PFO的敏感度（98.88%）及特异度（100%）均高于cTTE（89.89%、75.00%;χ²=6.125、5.143,P=0.008、0.016）;cTEE的PFO-RLS分级结果总体低于cTTE（Z=-3.464,P=0.001）。结论 cTEE诊断PFO的敏感度及特异度均高于cTTE,而其PFO-RLS分级总体低于cTTE。     

卵圆孔未闭与偏头痛发病相关性的Meta分析

目的:采用Meta分析探讨卵圆孔未闭(PFO)与偏头痛发病的相关性。方法:计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、VIP、WanFang Data及CBM数据库,收集观察PFO与偏头痛发病相关性的病例对照研究或横断面研究或队列研究,检索时限从建库至2018年8月1日。由两名评价者按照纳入与排除标准筛选文献、提取资料,并进行NOS文献质量评价,采用RevMan 5.3软件进行Meta分析。结果:共纳入30篇文献,样本量为9 177例。Meta分析结果显示偏头痛组与健康对照组PFO发生率差异有统计学意义(OR=3.19,95%CI为2.20～4.63,P0.01),先兆偏头痛组与健康对照组PFO发生率差异有统计学意义(OR=3.71,95%CI为2.13～6.46,P0.01),无先兆偏头痛组PFO发生率高于健康对照组(OR=1.48,95%CI为1.09～2.00,P=0.01),先兆性偏头痛组PFO发生率高于无先兆性偏头痛组(OR=2.32,95%CI为1.96～2.76,P0.01)。PFO组的偏头痛率高于健康对照组(OR=2.58,95%CI为1.57～4.25,P0.01)。结论:PFO与偏头痛存在明显相关性。     

超声心动图诊断卵圆孔未闭

卵圆孔未闭（PFO）在成人的发生率约20%~25%,其与年轻患者的隐源性卒中、短暂性脑缺血发等多种疾病有关。超声心动图在PFO的诊断、经皮封堵术中监测及术后随访中均有重要价值。本文对PFO的超声心动图诊断做一综述。     

Cryptogenic stroke and patent foramen ovale

A stroke of unknown etiology is commonly referred to as cryptogenic and is diagnosed in a considerable patient population of especially young age. Numerous case-control studies revealed a strong and consistent association between cryptogenic stroke and the presence of a patent foramen ovale. This relationship corroborates paradoxical embolism as likely stroke mechanism in this patient population. In approximately twenty-five percent of patients with cryptogenic stroke, the patent foramen ovale is accompanied by an atrial septal aneurysm, which considerably heightens the risk for recurrent neurological events. Therapeutic measures for secondary prevention in this patient population encompass medical treatment with antiplatelet agents or anticoagulants and surgical or percutaneous closure of patent foramen ovale. Currently, randomised clinical studies compare medical treatment with closure of patent foramen ovale to determine the most effective treatment strategy in this patient population.     

经胸超声心动图在卵圆孔未闭封堵术中的应用

目的 探讨经胸超声心动图（TFE）在卵圆孔未闭（PFO）封堵术中的应用价值。方法回顾性分析43例PFO患者在封堵术前、术中及术后的TTE图像特征。结果 TTE在术前可清晰显示PFO的大小、形态和分流方向,能帮助介入医师选择合适的封堵器;术中可准确地评价PFO患者封堵器的位置、形态及其与周边的临近结构关系;术后可有效地监控PFO患者预后情况。结论 TTE在PFO封堵术前确诊、术中引导、监护及术后随访均具有重要的作用。     

Migraine,patent foramen ovale and migraine triggers

Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura (p<0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MAgroup OR 2.7 [1.02–7.17] and in all migraine patients OR 2.5 [1.01–6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.     

Clinical manifestation and current management of patent foramen ovale

There is increasing interest in the evaluation and treatment of patent foramen ovale, which has been associated with various pathologic conditions, such as cryptogenic stroke, platypnea–orthodeoxia syndrome and migraine. However, optimal treatment of patients with patent foramen ovale has not been established. This article aims to review the clinical manifestation and current therapeutic options for patent foramen ovale.     

High prevalence of patent foramen ovale in migraine with aura

In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour–coded sonography (c–TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c–TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c–TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.