卵圆孔未闭合并偏头痛患者行经股静脉介入封堵术的临床疗效和安全性分析

Clinical efficacy and safety analysis of transfemoral vein occlusion in patients with patent foramen ovale and migraine

目的 探讨卵圆孔未闭(patent foramen ovale,PFO)合并偏头痛患者行经股静脉介入封堵术的临床疗效和安全性。方法 回顾性研究乐山市人民医院心脏外科2018年5月至2019年2月收治的PFO合并偏头痛并行经股静脉介入封堵术患者163例,比较所有患者术前、术后1、6个月经胸心脏超声心动图右心声学造影结果;比较所有患者术前、术后1、3、6个月头痛发作频率、持续时间、头痛程度评分。统计所有患者术后6个月手术疗效。结果 (1)所有患者均获随访,随访时间为6~12个月,平均(7.24±3.72)个月;所有患者术后6个月随访,163例患者中疗效显著患者151例,缓解8例,无效4例,所有患者手术有效率97.55%。(2)所有患者术前均存在不同程度的分流,术后1个月、术后6个月分流情况较术前明显好转(P<0.05),术后6个月分流情况明显优于术后1个月(P<0.05),差异均有统计学意义。(3)所有患者术后1、3、6个月头痛发作频率及持续时间明显低于术前,差异有统计学意义(P<0.05);随着时间推移,头痛发作频繁及持续时间也明显减少。(4)所有患者术后1、3、6个月头痛影响测评量表-6(headache impact test-6,HIT-6)评分、视觉模拟评分法(visual analogue scale,VAS)评分及偏头痛残疾程度评估问卷(migraine disability assessment questionnaire,MIDAS)评分明显低于术前,差异有统计学意义(P<0.05);随着时间推移,HIT-6评分、VAS评分及MIDAS评分明显降低。结论 PFO合并偏头痛患者行经股静脉介入封堵术治疗,手术创伤小、恢复快,能够明显改变右向左分流情况,同时改善患者头痛程度以及临床症状,并且有效性及安全性较高,值得临床进一步推广。

Objectives To investigate the clinical efficacy and safety of transfemoral vein occlusion in patients with patent foramen ovale(PFO)and migraine.Methods We present a retrospective study of 163 patients with PFO and migraine who received cardiac surgeries(transfemoral vein occlusion)in The People′s Hospital of Leshan from May 2018 to February 2019. The results of right heart contrast echocardiography before and 1,6 months after operation were compared,so did the frequency,duration and degree of headache before and 1,3,6 months after operation. The surgical outcomes of all the patients at 6 months postoperatively were counted.Results (1)All the patients were followed up for 6-12 months,with an average of(7.24±3.72)months. Among the 163 patients followed up for 6 months,151 cases had significant effects,8 cases had remissions,and 4 cases were ineffective. The surgical efficiency of all the patients was 97.55%.(2)All the patients had different degrees of shunts before surgery. One month and 6 months after operation,the shunt situation was significantly improved(P<0.05),and the shunt situation at 6 months after surgery was significantly better than 1 month after operation(P<0.05).(3)The frequency and duration of headache attacks were significantly lower in all the patients at 1,3 and 6 months after surgery(P<0.05)than before and decreased significantly with time.(4)All the headache impact test-6(HIT-6)score,visual analogue scale(VAS)score,and migraine disability assessment questionnaire(MIDAS)score of the patients at 1,3 and 6 months after surgery were significantly lower than those before surgery(P<0.05). With time,the HIT-6 score,VAS score and MIDAS score decreased significantly.Conclusions The patients with PFO and migraine could be treated with transfemoral vein occlusion,which is less invasive with quicker recovery,can significantly change the right-to-left shunt situation,and improve the degree of headache and clinical symptoms of patients. The efficacy and safety are high,so it is worthy of further clinical promotion.