摘要
目的观察TCD发泡试验(c-TCD)对偏头痛患者筛查卵圆孔未闭(PFO)的价值及封堵PFO后的疗效。方法偏头痛患者126例,男45例,女81例,平均年龄42.3±3.6岁,其中先兆偏头痛(MA)78例,非先兆偏头痛(MO)48例。所有患者均行c-TCD、食道超声心动图(TEE)及头部CT检查。对诊断为卵圆孔未闭且同意封堵治疗的患者进行经皮穿刺介入封堵治疗,并在封堵术后1m、3m行c-TCD及常规经胸心脏超声心动图(TTE)检查,在术后6m行TTE联合TCD声学造影及头部CT检查。结果 126例偏头痛患者中,46例(36.5%)c-TCD提示心脏存在右向左分流且TEE证实存在卵圆孔未闭,其中MA 32例,MO 14例;12例(MA 8例,MO 4例)接受介入封堵治疗,其中10例封堵术后偏头痛症状消失,2例封堵术后患者偏头痛症状明显改善;4例封堵术后3m内c-TCD提示存在右向左分流,较术前明显减少,其中2例仅在Valsalva动作后出现。封堵术后6m c-TCD联合TTE声学造影检查,2例(均为术后3m常规c-TCD阳性)患者仍存在右向左分流,所有头部CT无新发梗死病灶。结论 c-TCD对PFO的筛查及介入封堵术后随访具有重要指导价值;介入封堵治疗可明显改善合并PFO患者的偏头痛症状;封堵治疗6m后仍有部分患者存在残余右向左分流。
Objective Patent foramen ovale （PFO） is one of the etiologies that cause the migraine. Transcatheter PFO closure can reduce the occurrence of aheadache episodes. Transcranial Doppler ultrasound （TCD）can increase the op- portunities of successfully diagnosing, screening the PFO and discover the residual shunt after the transcatheter closure. Methods We had enrolled 126 migraine patients （male 45, female 81, mean age 42.3 ± 3.6 ys）from August 2010 to September 2012 in our hospital ,including 78 cases of migraine with aura （MA） ,48 cases of non-migraine with aura （MO）. All patients underwent eontrast-transeranial-doppler （c-TCD）, transesophageal echocardiography （TEE）and head computed tomography examinations （CT）. The patients who were diagnosed the patent foramen ovale and agreed transeatheter therapy in the cases were taken the percutaneous transcatheter closure therapy, and then hold on the c-TCD and transthoracic echo- cardiography （TTE）at 1 month ,3 months after the transcatheter closure. The c-TCD and contrast transthoraeic echocardio- graphy were perfotmed simultaneously and the head CT was screened at 6 months after transcatheter closure. Results The c-TCD discovered 46/126 patients existing right-to-left shunt in the heart ,which were confirmed the presence of the PFO by TEE,including 32/46 cases of the MA and 14 cases of the MO. 12 patients （ MA 8, MO 4） accepted the transeatheter clo- sure therapy. There weare 10 cases of the migraine symptoms disappeared and 2 cases reduced the onset of migraine symp- toms significantly after transcatheter closure. There were 4 cases which showed the presence of the right to left shunt de- creased significantly comparing with the preoperative at 3 months after the transcatheter closure with the c-TCD, including two cases only after the Valsalva maneuver. There were 2 patients （the conventional c-TCD positive after 3 months）still ex- isting a right to left shunt by c-TCD joint contrast TTE and no new stroke was detected by CT a
出处
《中风与神经疾病杂志》
CAS
CSCD
北大核心
2013年第3期234-237,共4页
Journal of Apoplexy and Nervous Diseases
基金
大连市领军人才支持项目(2012)
关键词
卵圆孔未闭
偏头痛
经颅多普勒超声
经胸超声心动图
介入封堵治疗
Patent foramen ovale
Migraine
Transcranial doppler uhrasound
Transthoraeic echoeardio- graphy
Transcatheter closure treatment
