经颅多普勒发泡试验在卵圆孔未闭合并偏头痛患者筛查及封堵术疗效评估中的应用价值.docVIP

经颅多普勒发泡试验在卵圆孔未闭合并偏头痛患者筛查及封堵术疗效评估中的应用价值 　　[摘要] 目的 ?^察经颅多普勒（TCD）发泡试验在卵圆孔未闭（PFO）合并偏头痛患者筛查价值及封堵PFO后的疗效。 方法 选取2016年1～12月延安大学附属医院收治的偏头痛患者80例为偏头痛组，其中先兆偏头痛（MA）51例，非先兆偏头痛（MO）29例，另选择同期于健康体检的30名健康者作为对照组，两组均行TCD发泡试验；偏头痛组行食道超声心动图、头部CT检查。对确诊为卵圆孔未闭且同意封堵治疗的患者经皮穿刺介入封堵治疗，在封堵术后1、3个月行TCD发泡试验及常规经胸心脏超声心动图及头部CT检查，以观察封堵术疗效。 结果 偏头痛组TCD发泡试验检测37例存在右向左分流，且经食道超声心动图检查证实存在卵圆孔未闭，其中Ⅱ级患者13例，Ⅲ级患者19例，Ⅳ级患者5例；对照组中Ⅱ级患者5例，Ⅲ级患者2例，无Ⅳ级患者，两组RLS分流情况比较，差异有统计学意义（P 0.05）。20例患者（MA患者13例，MO患者7例）接受介入封堵治疗，手术成功，12例患者术后偏头痛症状消失，5例患者症状明显改善，3例患者术后3个月内TCD发泡试验仍提示存在右向左分流，但偏头痛症状较术前明显减少，其中2例患者仅在Valsalva动作后出现症状，1例患者手术前后均为Ⅳ级。所有患者复查头部CT检测均未发现新发梗死病灶。 结论 介入封堵治疗可明显改善PFO合并偏头痛患者的症状，TCD发泡试验在卵圆孔未闭合并偏头痛患者筛查及疗效评估中的具有重要的应用价值。 　　[关键词] 经颅多普勒；发泡试验；偏头痛；卵圆孔未闭；介入封堵治疗 　　[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210（2017）09（a）-0127-04 　　[Abstract] Objective To analyze the application value of TCD foam test in screening and curative effect evaluation of migraine patients with patent foramen ovale. Methods From January to December 2016， in Yanan University Affiliated Hospital， 80 migraine patients were selected as the MA group， there were 51 patients of migraine aura （MA）， 29 patients of migraine aura （MO），30 healthy persons carried physical examination were selected as control group， TCD foaming test was carried in both two groups， and the MA group was given the esophagus echocardiography， head CT examination in addition， the percutaneous puncture in sealing treatment was carried among patients who diagnosed as patent foramen ovale and agreed to percutaneous puncture seal treatment， and the effect of intervention plugging treatment was observed by TCD foaming test， conventional chest cardiac echocardiography， head CT examination 1 and 3 months postoperative. Results TCD foaming test showed that， there were 37 patients with right-to-left shunt in the MA group， and they were confirmed by the esophagus echocardiography， including 13 cases were grade Ⅱ， 19 cases were grade Ⅲ， and 15 cases were grade Ⅳ； in control group， 5 cases were grade Ⅱ， 2 cases w