封堵术对卵圆孔未闭伴偏头痛的作用

Effect of occlusion on patent oval foramen complicated by migraine

目的探讨卵圆孔未闭(PFO)伴偏头痛的影响因素,以及卵圆孔封堵后对PFO伴偏头痛的疗效。方法选取2014年1月至2019年12月于郑州市第七人民医院心内科诊断PFO患者70例,其中合并偏头痛者42例(PFO组)。另选取同期我院非PFO者95例,其中合并偏头痛者30例(非PFO组)。对比两组偏头痛的发生数,同时比较PFO右向左分流(RLS)不同分级对偏头痛的发生以及严重程度的影响。对比其中PFO组中38例患者成功行卵圆孔封堵术前后头痛严重程度以及头痛对生活质量影响评分。结果PFO组偏头痛发病人数较非PFO组明显偏高,差异有统计学意义(χ^(2)=14.28,P<0.05);RLS分级与偏头痛的发生及头痛程度呈正相关,差异有统计学意义(χ^(2)=6.308,24.86,P<0.05,γ=0.600)。对比封堵1年后头痛评分以及头痛影响生活质量因子-6评分均较术前明显降低,差异有统计学意义(t=31.49,5.98,P<0.05)。患者术后1年随访时均未发现心内膜炎、原位血栓形成、封堵器脱落等并发症。结论PFO患者右向左分流量越大其偏头痛发生率以及头痛程度越高。对PFO合并顽固性偏头痛患者,行封堵术治疗能有效减轻其头痛程度,改善其生活质量,且安全可靠。

Objective To investigate the influence factors of patent oval foramen(PFO)complicated by migraine and curative effect of PFO occlusion.Methods PFO patients(n=70),of them 42 were complicated by migraine,were chosen into PFO group from Department of Cardiology in the Seventh People’s Hospital of Zhengzhou City from Jan.2014 to Dec.2019.At the same period,95 non-PFO patients,of them 30 complicated by migraine,were chosen into non-PFO group.The number of migraine cases was compared,and influence of different grades of PFO right-to-left shunt(RLS)on incidence and severity of migraine was compared between 2 groups.The severity of headache and headache impact test-6(HIT-6)on quality of life(QOL)were compared in 38 patients in PFO group before and after successful PFO occlusion.Results The number of migraine cases was significantly higher in PFO group than that in non-PFO group(χ^(2)=14.28,P<0.05).RLS grades were positively correlated to incidence and severity of migraine(χ^(2)=6.308,24.86,P<0.05,γ=0.600).The impact scores of headache(t=31.49)and HIT-6 on QLO(t=5.98)decreased significantly after 1 y compared with before PFO occlusion(P<0.05).There were no complications observed including endocarditis,thrombosis in situ and occluder detachment during 1-y follow-up period.Conclusion The higher the RLS,the higher the migraine incidence rate and severity in PFO patients.PFO occlusion can effectively headache severity and improve QOL in PFO patients complicated by refractory migraine,which is safe and reliable.