介入封堵术治疗缺血性脑卒中合并卵圆孔未闭患者的短期疗效

Short-term efficacy of transcatheter closure for ischemic stroke patients with patent foramen ovale

目的:探讨介入封堵术治疗缺血性脑卒中合并卵圆孔未闭(PFO)患者的短期疗效。方法:126例缺血性脑卒中合并PFO患者,均具备PFO介入封堵术指征,根据患者意愿分为手术组(n=57)和药物组(n=69)。手术组行介入封堵术治疗,术后接受心脏彩超、心电图等检查;药物组给予阿司匹林+氯吡格雷抗血小板聚集治疗。所有患者通过电话、微信或门诊复查等途径保持随访6个月,观察两组患者复发性缺血性脑卒中发生率,比较两组患者合并偏头痛患者头痛影响测试(HIT-6)评分情况,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和中文版简明生活质量评价量表(SF-36)评估两组患者生活质量变化情况。结果:手术组54例成功完成介入封堵治疗,术中cTCD增强发泡试验,CTTE检查未见残余分流或仅残存少量分流。两组均成功随访6个月,手术组缺血性脑卒中复发率为1.85%,明显低于药物组的13.85%,差异有统计学意义(χ^2=4.065,P<0.05)。治疗6个月后,两组合并偏头痛患者HIT-6评分均较治疗前明显下降(t=26.197、8.774,P<0.05),且手术组低于药物组,差异有统计学意义(t=17.877,P<0.05)。治疗6个月后,两组HAMA、HAMD评分较治疗前明显下降,SF-36量表评分明显提高,差异有统计学意义(P<0.05),且手术组HAMA、HAMD评分低于药物组,SF-36评分高于药物组,差异有统计学意义(t=3.286、2.966、5.941,P<0.05)。结论:介入封堵术治疗缺血性脑卒中合并PFO短期疗效显著,有效预防复发性卒中发生和缓解偏头痛症状,显著提高患者生活质量。

Objective:To investigate the short-term efficacy of transcatheter closure for ischemic stroke patients with patent foramen ovale(PFO).Methods:126 patients with ischemic stroke and PFO were divided into operation group(n=57)and drug group(n=69)according to the patients'wishes.The operation group was treated by interventional occlusion,and the patients were examined by color Doppler echocardiography and electrocardiography.The drug group was given aspirin+clopidogrel to prevent platelet aggregation set therapy.All patients were followed up for at least 6 months by telephone,wechat or outpatient reexamination.The incidence of recurrent ischemic stroke was observed in the two groups,and the score of headache influence test(HIT-6)was compared between the two groups.The health of the two groups was assessed by Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and simplified quality of life assessment scale(SF-36)changes in living quality.Results:54 patients in the operation group successfully completed the transcatheter closure,and no residual shunt or a small residual shunt was found in the CTTE and the Ctcd enhanced foaming test.Both groups were successfully followed up for 6 months.The recurrence rate of ischemic stroke in the operation group was 1.85%,which was lower than that in the drug group(13.85%),the difference was statistically significant(χ^2=4.065,P<0.05).The HIT-6 scores of the patients with migraine in the two groups were significantly lower than those before treatment(t=26.197,8.774,P<0.05),the score of HIT-6 in operation group was significantly lower than that in drug group(t=17.877,P<0.05).After 6 months of treatment,the scores of HAMA and HAMD in the two groups were significantly lower than those before treatment,and the scores of SF-36 were significantly higher(P<0.05).The scores of HAMA and HAMD in the operation group were lower than those in the drug group,and the scores of SF-36 were higher than those in the drug group,the differences were statistically significant(t=3.286,2.966,5.941,P<0.05).Conclusion:The short-term curative effect of interventional closure is significant in the treatment of ischemic stroke combined with PFO.It can effectively prevent recurrent stroke and relieve migraine symptoms,and significantly improve the quality of life of patients.