房间隔缺损封堵术后头痛与封堵器形态相关分析

Correlation analysis on headache accompanied by atrial septal defect occlusion and morphometric characteristics of occluder

目的:研究房间隔缺损封堵术后头痛与封堵器形态之间的关系,以此探讨术后头痛的原因和机制。方法:继发孔型房间隔缺损患者183(男66,女117)例,年龄6～72(30.1±18.5)岁。经胸心动超声(transthoracic echocar-diography,TTE)测量房间隔缺损最大直径为8～35(19.8±7.5)mm,选用的封堵器大小为10～44(25.9±8.9)mm。结果:术后3个月新出现头痛症状患者为16例,发生率为8.7%。头痛组房间隔缺损(atrial septal defect,ASD)缺损大小为(27.3±6.2)mm,无头痛组为(17.1±7.2)mm,头痛组缺损明显大于无头痛组(P<0.01)。头痛组封堵器直径、超声测量封堵器的厚度均较无头痛组大(均P<0.01)。封堵器直径与缺损大小的差值和封堵器直径与术后封堵器直径的差值头痛组亦明显大于无头痛组(P<0.05或P<0.01)。多因素相关分析显示,头痛与封堵器厚度显著相关(P<0.01),而与年龄、缺损大小、封堵器直径等不相关。结论:封堵器厚度越厚,头痛症状发生率越高。头痛可能与封堵器表面内皮化不全或内皮化进程延长有关。

AIM： This study investigated the causes and mechanism for headache observed after atrial septal defect（ASD） occlusion by studying the correlation between headache and the geometric characteristics of the occluder.METHODS： One hundred eighty three patients（66 male,117 female） with secundum ASD were included with ages of 6-72（30.1±18.5） years.The maximum size of the defect was in the range of 8-35 mm（19.8±7.5） mm,measured by transthoracic echocardiography（TTE）.Sizes of the occluders used were 10-44 mm（25.9±8.9）.RESULTS： Sixteen patients（8.7% of all patients） reported a postoperative headache after 3 months.The group with reported headache had significantly greater ASD defect sizes（27.3±6.2） mm compared with the defect sizes in the group without headache [（17.1±7.2） mm,P〈0.01].In the group with headaches,both the diameter and thickness（measured by ultrasound） of the occluder were significantly larger than those used in the group without headaches（P〈0.01）.The difference between the occluder diameter and the defect size,as well as the difference between the original and postoperative diameters of the occluder,were significantly larger in the group with headaches compared to the group without headaches（P〈0.05 and P〈0.01,respectively）.Correlation analysis demonstrated that the incidence rate of a headache was significantly related to the thickness of the occluder（P〈0.01） but independent of age,defect size,occluder diameter,and other morphometric indicators.CONCLUSION： The higher incidence of headache after ASD occlusion positively correlates with the thickness of the occluder.We speculate that headache may be caused by the incomplete endothelialization of the surface of the occluding device or to prolonged endothelialization process.