卵圆孔未闭合并脑梗死的危险因素及经食道超声引导下的封堵价值

Analysis of risk factors of patent foramen ovale complicated with cerebral infarction and the value of transesophageal ultrasound-guided occlusion

目的:探讨卵圆孔未闭合并脑梗死的危险因素及经食道超声引导下的封堵价值。方法:选取120例卵圆孔未闭患者为研究对象,依据是否发生脑梗死分为单纯卵圆孔未闭组(n=78)和卵圆孔未闭合并脑梗死组(n=42);卵圆孔未闭合并脑梗死组再根据治疗方式不同分为常规治疗组(n=18)和介入封堵组(n=24)。分析卵圆孔未闭合并脑梗死的危险因素;比较卵圆孔未闭合并脑梗死组不同治疗方式患者的临床疗效、头痛程度[头痛影响测评量表6(HIT-6)评分]和脑梗死相关并发症发生情况。结果:单因素及多因素分析显示,年龄、患有高血压和糖尿病、红细胞分布宽度变异系数和纤维蛋白原异常是卵圆孔未闭患者发生脑梗死的危险因素(P<0.05)。介入封堵组患者治疗总有效率高于常规治疗组(83.33%vs.50.00%,P<0.05);HIT-6评分低于常规治疗组[(32.15±4.08)分vs.(47.26±4.63)分,P<0.05];脑梗死相关症状并发症发生率低于常规治疗组(4.17%vs.44.44%,P<0.05)。结论:高龄、患有高血压和糖尿病、红细胞分布宽度变异系数及纤维蛋白原指标异常均是卵圆孔未闭患者发生脑梗死的危险因素;经食道超声引导下的封堵术能提高卵圆孔未闭合并脑梗死患者的临床疗效,降低头痛程度和脑梗死相关症并发症的发生率,值得临床推广应用。

Objective:To investigate the risk factors of unclosed foramen ovale with cerebral infarction and to further observe the value of transesophageal ultrasound-guided occlusion.Methods:120 patients with visible foramen ovale were selected as the research subjects.They were divided into two groups based on whether there was cerebral infarction:simple patent foramen ovale group(n=78)and patent foramen ovale mixed with cerebral infarction group(n=42).The patent foramen ovale mixed with cerebral infarction group was further divided into conventional treatment group(n=18)and interventional occlusion group(n=24)based on different treatment methods.The risk factors of patent foramen ovale combined with cerebral infarction were analyzed.The clinical efficacy,headache severity(HIT-6 score),and incidence of cerebral infarction related complications were compared in patients with patent foramen ovale complicated by cerebral infarction treated with different treatment methods.Results:By univariate and multifactorial analyses,it was found that increasing age,suffering from hypertension,diabetes mellitus,coefficient of variation of the width of the distribution of erythrocytes and abnormalities of fibrinogen were risk factors for the occurrence of cerebral infarction in patients with patent foramen ovale(P<0.05).The clinical efficacy in the interventional occlusion group was higher than that in the conventional treatment group(83.33%vs.50.00%,P<0.05).HIT-6 score of the interventional occlusion group was lower than that of the conventional treatment group(32.15±4.08 vs.47.26±4.63,P<0.05).The recurrence rate of cerebral infarction-related symptoms of the interventional blockage group was lower than that of the conventional treatment group(4.17%vs.44.44%,P<0.05).Conclusion:Elderly people,people with hypertension and diabetes,abnormal red blood cell distribution width coefficient of variation and fibrinogen index are all risk factors for cerebral infarction in patients with patent foramen ovale.The occlusion surgery guided by esophageal ultrasound can improve the clinical efficacy of patients with patent foramen ovale complicated with cerebral infarction,reduce the degree of headache and the incidence of complications related to cerebral infarction,and is worthy of clinical promotion and application.