摘要
卵圆孔是心脏房间隔上胚胎时期遗留下来的一个通道,存在于胎儿期和近1/4的成人,是一个潜在的血栓由自体静脉系统至脑及外周动脉栓塞的途径。正常情况下,卵圆孔未闭(patent foramen ovale,PFO)不引起任何临床症状,但当右心房压力一过性或持续性增高时,可引起心房间右向左分流,身体其他部位的栓子或原位血栓就有可能脱落,造成反常栓塞(paradoxical embolism,PDE)。PDE可引起一系列临床综合征,包括不明原因脑卒中(cryptogenic stroke,CS)、偏头痛、斜卧呼吸-直立型低氧血症、睡眠呼吸暂停综合征、冠脉正常的心肌梗死、脑白质病变及神经减压病所造成的动脉气体栓塞等。但由于主动脉弓的特殊解剖及大脑较其他器官对缺血更敏感,故临床上大部分PDE都表现为短暂性脑缺血发作(transient ischemic attack,TIA)或CS。尽管已有许多令人信服的证据涉及PFO与CS,但其确切发病机制尚未完全明确。本文重点介绍了目前PFO所致PDE并发CS的当前研究现状,尤其是几个随机对照试验(randomized controlled trials,RCT)的结果,以期对我国今后PFO并发CS的治疗提出新的观点。
The foramen ovale is a normal interatrial communication during fetal life that persists after birth in approximately 1/4 adults. The foramen ovale is a potential route for embolic transit from the systemic venous circulation to the brain. In the basal state and peripheral arterial embolism route, patent foramen ovale （PFO） does not cause any clinical symptom. When the pressure of the right atrium transiently or persistently exceeds the pressure of left atrum, right-to-left shunt happens. Emboli or primal.y thrombus of other body regions is likely to break off, resuhing in paradoxical embolism （PDE）. PDE has been associated with a series of clinical syndromes includingyptugenic stroke （CS）, migraine, systemic hypoxemia from recumbent position breathing-orthodeoxia, obstructive sleep apnea syndrome, myocardial inarction with normal coronary, cerebral white matter lesions and arterial gas embolism from neural （cerebral？） decompression illness. However, due to the special anatomy of the aortic arch anti brain isehemia, it is more sensitive than other organs. Most PDE assumed transient ischemiattack （TIA） or CS. Althoughthere is convincing circumstantial evidence implicating PFO with CS, the precise role of PFO in the patho- genesis of CS is not still completely understood. This article focuses on the present condition of the study on PDE and CS, especially the results of randomized controlled trials. We expect the above results to propose a new perspective on the treatment of PFO with CS.
出处
《心脏杂志》
CAS
2013年第1期1-5,共5页
Chinese Heart Journal
关键词
卵圆孔未闭
反常栓塞
不明原因脑卒中
随机对照试验
治疗
patent foramen ovale
paradoxical embolism
cryptogenic stroke
randomized controlled trials
treatment
