经颅多普勒同步经胸壁心脏超声发泡试验诊断偏头痛并卵圆孔未闭及封堵治疗分析

Clinical analysis of c-TCD and c-TTE test in diagnosis and curative effect evaluation of migraine patients with patent foramen ovale and transcatheter closure treatment

目的观察经颅多普勒超声(c-TCD)和经胸壁心脏超声发泡试验(c-TTE)对诊断偏头痛合并卵圆孔未闭(PFO)的应用价值,以及对确诊卵圆孔未闭的偏头痛患者行卵圆孔未闭封堵术后的疗效评估价值。方法选取2013年11月-2017年4月我院收治的偏头痛患者,进行c-TCD联合c-TTE检查,筛查出阳性结果者,进一步行经食道心脏超声(TEE)确诊卵圆孔未闭,对确诊卵圆孔未闭的偏头痛患者行卵圆孔未闭封堵术,术后随访病例,同时进行c-TCD、c-TCD联合c-TTE检查。结果386例患者c-TCD检查阳性率38.56%,c-TCD联合c-TTE检查阳性率32.64%,差异无统计学意义;其中37例患者接受介入封堵术治疗10例患者偏头痛症状完全消失,14例患者症状明显改善;6个月内随访,21例患者两项检查结果均为阴性;16例c-TTE仍为阳性,但气泡量均有明显减少(1级),其中11例c-TCD为阳性结果,均为少量气栓影(1级)。结论c-TCD联合c-TTE可运用于偏头痛并卵圆孔未闭诊断,且半定量方法可提高PFO确诊及术后治疗效果评价的敏感性和准确性。

Objective Comparison of contrast transcranialdoppler(c-TCD)and contrasttransthoracic echocardiography(cTTE)and the combined application of the two methods indetectingmigraine patients with patent foramen ovale(PFO)and after the transcatheter closure.Methods We had enrolled migraine patients from November 2013 to April 2017 in our hospital.All patient underwent c-TCD and cTTE,Patients with either of the examinationabove found positive were selected to finish transeso-phageal echocardiography(TEE),the percutaneous puncture in sealing treatment was carried among patients who diagnosed as patentforamen ovale and agreed to percutaneous puncture seal treatment,and the effect of intervention plugging treatment wasobserved by c-TCD and c-TTE test1、3 and 6 months postoperative.Results In our study,the sensitivities of group c-TCDand group c-TCD and c-TTEpositive did not have any statistical difference(38.56 vs.32.64%);There are 37 patients accepted the transcatheter closure therapy.There were 10 cases of the migraine symptoms disappeated and 14 cases reduced the onset of migraine symptoms significantly.At 6months follow up,21 patients in the intervention closure group were grade 0 with right-to-left,but 16 patients(the conventional c-TTE)were grade 1,11 patients(the conventional c-TCD)were grade.Conclusion c-TCD combined with c-TTE can be used in the diagnosis of migraine with PFO,and the semi-quantitative method can improve the sensitivity and accuracy of PFO diagnosis and postoperative therapeutic effect evaluation.