老年卵圆孔未闭相关隐源性卒中研究进展

Research progress on cryptogenic apoplexy associated with patent foramen ovale in the elderly

本文从老年卵圆孔未闭(PFO)相关隐源性卒中的流行病学、病理生理机制、诊断方法、治疗方法和预后等方面展开,就老年PFO相关隐源性卒中研究进展作一述评。PFO在老年人中的检出率较低,但与PFO相关的卒中患病率较高。老年隐源性卒中患者的PFO检出率明显高于已知病因卒中患者。此外,同时患有PFO和其他心脏异常的老年患者发生隐源性卒中的风险更高。老年PFO相关隐源性卒中的诊断首先需要确定卒中是否为血栓性卒中,可通过详细的病史、体格检查和影像学检查来排除其他原因,并通过超声心动图或经颅多普勒超声检查来确认PFO。老年PFO相关隐源性卒中的治疗方法主要包括药物治疗(抗血小板药物、抗凝剂等)和手术干预(经皮介入闭合术、外科闭合术等)。与年轻患者相比,老年患者接受PFO闭合术的治疗效果较差,术后心房扑动、心房颤动等并发症发生率较高。

This article reviews the epidemiology,pathophysiological mechanisms,diagnostic methods,treatment methods,and prognosis of cryptogenic stroke related to patent foramen ovale(PFO)in the elderly.The detection rate of PFO in the elderly is relatively low,but the incidence of stroke related to PFO is relatively high.The detection rate of PFO in elderly patients with cryptogenic stroke is significantly higher than that in patients with known causes of stroke.In addition,elderly patients with both PFO and other cardiac abnormalities have a higher risk of developing cryptogenic stroke.The diagnosis of cryptogenic stroke related to PFO in the elderly first requires determining whether the stroke is thrombotic,which can be excluded by a detailed medical history,physical examination,and imaging studies,and confirmed by echocardiography or transcranial Doppler ultrasound.The main treatment methods for cryptogenic stroke related to PFO in the elderly include drug therapy(antiplatelet drugs,anticoagulants,etc.)and surgical intervention(percutaneous interventional closure,surgical closure,etc.).Compared with young patients,the therapeutic effect of PFO closure surgery in elderly patients is relatively poor,and the incidence of postoperative complications such as atrial flutter and atrial fibrillation is relatively high.