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。

Clinical Study of Patent Foramen Ovale Transcatheter Closure on Migraine Patients Combined with Right-to-left Shunt

To evaluate the clinical efficacy and safety of patent foramen ovale (PFO) transcatheter closure treatment on patients who have migraine with right-to-left shunt (RLS). Methods: One hundred and fourteen patients with migraine combined with RLS were randomized into operation group (to undergo PFO transcatheter closure, n=57) or control group (to receive conventional medical therapy, n=57). The headache-impact-test score (HIT-6) and the reduction to baseline in HIT-6 at one year after treatment were compared between 2 groups. The incidence rates of complications at one month and one year after treatment, the residual RLS at 24 h and one year after treatment, and the new onset of cerebral infarction at one year after treatment were compared. Results: One year after treatment, the HIT-6 grade was (49.57 ± 4.58) and the difference value was (14.38±3.57) in the operated group, and the values were (56.85±5.69) and (8.64±2.24) in the control group respectively (P<0.05). There were 11 (19.30%) patients with complications which disappeared after one year of operation. There were 8 (14.04% ) patients with large residual shunt at 24 h while only 1 (1.92%) patient with large residual shunt after one year of operation. Seven in operation group and 17 in control group developed new cerebral infarction after one year (P<0.05). Conclusion: PFO closure is a safe and effective way to treat patients who have migraine with RLS. It can also reduce the risk of stroke