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什么时候医生应该考虑将疑似PFO相关中风的老年患者转诊给设备关闭?

Alisha Varia¹, David Roberts¹

¹School of Medicine, University of Liverpool, Liverpool L69 3GE, UK.

Journal of clinical medicine

|January 10, 2026

概括

在老年患者 (≥60岁) 中,卵孔 (PFO) 关闭减少了复发性中风和死亡率. 虽然对二次预防有希望,但由于研究的局限性,需要进一步进行标准化试验.

科学领域:

心脏病学心脏病学
神经学神经学
临床试验临床试验

背景情况:

目前的指导方针建议PFO关闭,以预防年轻成年人 (18-65岁) 的中风.
在老年患者 (≥60岁) 中PFO关闭的证据仍然有限.
这项研究评估了PFO关闭与单独治疗老年人后密码性中风的药物治疗.

研究的目的:

评估PFO关闭的疗效和安全性,与单独使用药物治疗相比,在密码性中风后的老年患者 (≥60岁) 中.
评估现有试验在这个人群中的方法质量.
在老年人中为PFO关闭提供潜在指导方针建议的信息.

主要方法:

一项系统的文献搜索确定了四项相关研究 (PFOSK,PT,DEFENSE,PFOG).
主要分析的重点是研究质量:患者选择,分配,交叉和坚持.
二次分析比较了结果,包括复发性缺血事件,死亡率,新发性心房动 (AF) 和残疾.

主要成果:

在644名老年患者中,PFO关闭显著降低了复发性脑缺血 (45%的减少) 和死亡率 (85%的减少).
关闭组的残疾分数较低,但新发性肌肉关节炎的发病率较高 (RR 2.15).
研究质量受到治疗异质性,交叉和基线失衡 (年龄,分流尺寸) 的限制.

结论:

在60岁以上的患者中,PFO关闭似乎可以减少缺血事件的复发和死亡率,特别是那些具有高风险PFO特征的患者.
研究设计的变化和低事件率限制了这些发现的确定性.
大规模的标准化试验是必要的,以便在这个人群中建立指导方针建议的最终证据.

关键词:

在PFO关闭.密码性脑中风是什么意思密码性脑中风年长的老人老年人老年人.

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