经皮封堵术在55岁以上高危卵圆孔未闭患者中的临床疗效分析

Clinical analysis of percutaneous closure in aged over 55 years patients with high-risk patent foramen ovale

目的探讨年龄大于55岁的高危卵圆孔未闭(patent foramen ovale,PFO)患者行经皮封堵术的必要性、临床疗效及预后。方法选取2015年1月至2018年12月衡水市人民医院心外科行PFO封堵术的患者共60例,其中年龄大于55岁的患者24例(A组),年龄小于55岁患者36例(B组);观察A、B两组患者的手术成功率、手术及术后并发症发生率、短暂性脑缺血发作(transient ischemic attack,TIA)或隐匿性脑卒中等反常栓塞事件复发率等预后情况。选取同期行药物治疗的年龄大于55岁的高危PFO患者30例为对照组(C组)。结果A、B两组患者手术成功率比较,差异无统计学意义(P>0.05)。A组术后新发心房颤动的发生率高于B组,差异有统计学意义(P<0.05)。A组术后残余分流的发生率高于B组,差异有统计学意义(P<0.05)。两组患者PFO相关的反常栓塞事件复发率比较,差异无统计学意义(P>0.05)。A组与C组一般临床资料比较,差异无统计学意义(P>0.05)。A组的TIA或隐匿性脑卒中复发率明显低于C组,差异有统计学意义(P<0.05)。结论相对于药物治疗方案,经皮封堵术在年龄大于55岁的高危PFO患者有着更好的疗效,同时具有较高的手术安全性,因此对伴有TIA或隐匿性脑卒中的年龄大于55岁的PFO患者在除外禁忌症后,仍应考虑行经皮封堵术。

Objectives To investigate the necessity,clinical efficacy and prognosis of percutaneous closure in aged over 55 years patents with high-risk patent foramen ovale(PFO).Methods A total of 60 patients were selected from January 2015 to December 2018 in People′s Hospital of Hengshui City,who were underwent percutaneous closure of PFO,including 24 patients older than 55 years old(A group)and 36 patients younger than 55 years old(B group).Success rate of surgery,incidence of surgical and postoperative complications,recurrence rate of transient ischemic attack(TIA)or occult stroke and other prognostic conditions of patients in A group and B group were observed.Thirty elderly high-risk PFO patients receiving drug treatment at the same period were selected as control group(C group).Results There was no statistical difference in the success rate of operation between A group and B group(P>0.05).The incidence of new atrial fibrillation in A group was higher than that in B group,showing a statistical difference(P<0.05).The incidence of postoperative residual shunt was higher in A group than in B group(P<0.05),but there was no significant difference in the recurrence rate of migraine or occult stroke between the two groups(P>0.05).There was no statistical difference in general clinical data between A group and C group,but the recurrence rate of stroke or TIA in A group was significantly lower than that in C group,showing a statistical difference(P<0.05).Conclusions Compared with drug treatment,percutaneous closure is more safe and effective in aged over 55 years patients with high-risk PFO.Therefore,percutaneous closure should be considered in aged over 55 years patients with PFO complicating with TIA or occult stroke after contraindications are excluded.