偏头痛与卵圆孔未闭的关系及介入封堵术治疗效果分析

Correlation between migraine and patent foramen ovale and analysis of therapeutic efficacy of interventional occlusion

目的探讨偏头痛与卵圆孔未闭的关系,分析介入封堵术在偏头痛合并卵圆孔未闭患者中的应用效果。方法将138例偏头痛患者设为研究组,200名健康体检者设为对照组,比较两组卵圆孔未闭检出率,比较两组卵圆孔未闭检出者未闭卵圆孔直径及右向左分流分级。根据偏头痛合并卵圆孔未闭患者治疗方式不同分为联合组29例与药物组44例,联合组予以介入封堵术治疗,术后给予盐酸氟桂利嗪+阿司匹林治疗,药物组给予盐酸氟桂利嗪+阿司匹林治疗,观察1个月。治疗前后比较联合组与药物组发作频率、持续时间、头痛影响测评量表-6评分及脑血流动力学水平。结果研究组卵圆孔未闭检出率显著高于对照组(P<0.01),研究组卵圆孔未闭检出者未闭卵圆孔直径显著大于对照组(P<0.01),右向左分流分级显著高于对照组(P<0.01)。治疗后联合组与药物组头痛发作频率、持续时间、头痛影响测评量表-6评分均较治疗前显著下降(P<0.01),联合组显著低于药物组(P<0.01)。治疗后两组大脑中动脉、椎动脉、基底动脉血流速度均较治疗前显著下降(P<0.01),联合组显著低于药物组(P<0.01)。结论偏头痛与卵圆孔未闭具有一定联系,且与卵圆孔未闭严重程度有关,对合并卵圆孔未闭的偏头痛患者行介入封堵术能在药物治疗的基础上进一步改善患者症状,降低脑血流速度。

Objective To explore the relationship between migraine and patent foramen ovale(PFO),and to analyze the application effects of interventional occlusion in patients with migraine and PFO.Methods A total of 138 migraine patients were set as study group and 200 healthy people were set as control group.The detection rate of PFO between the two groups was compared,and the diameter of patent foramen ovale and right to left shunt(RLS) classification of the two groups of PFO patients were compared.According to the different treatment methods of patients with migraine and PFO,they were divided into combination group and drug group.The combination group was given flunarizine hydrochloride+ aspirin orally after interventional occlusion,and the drug group was given flunarizine hydrochloride+ aspirin orally for 1 month.The seizure frequency,duration,headache impact test(HIT-6) score and cerebral hemodynamics were compared between the combination group and the drug group before and after treatment.Results The detection rate of PFO in the study group was significantly higher than that in the control group(P<0.01),the diameter of patent foramen ovale of PFO patients in the study group was significantly larger than that in the control group(P<0.01),and the RLS classification was significantly higher than that in the control group(P<0.01).After treatment,the seizure frequency,duration and HIT-6 score in combination group and drug group were significantly lower than those before treatment(P<0.01),and the above indicators in combination group were significantly lower than those in drug group(P<0.01).After treatment,the blood flow velocity of the middle cerebral artery(MCA),vertebral artery(VA) and basilar artery(BA) in the two groups were significantly lower than those before treatment(P<0.01),and those in combination group were significantly lower than those in drug group(P<0.01).Conclusions Migraine has a certain relationship with PFO and is related to the severity of PFO.Interventional closure for migraine patients with PFO can further improve patients’ symptoms and reduce cerebral blood flow velocity on the basis of drug treatment.