肥厚型心肌病患者晕厥的临床分析(附92例报告)

An analysis of syncope in patients with hypertrophic cardiomyopathy (report of 92 cases)

目的探讨肥厚型心肌病患者出现晕厥的临床特点。方法将92例经超声心动图诊断为肥厚型心肌病的住院患者分为晕厥发作组(18例)和无晕厥发作组(74例),就两组的临床特征、心电变化和超声心动图特点进行分析。结果晕厥组发生流出道梗阻者[8例(44.4%)]明显超过非晕厥组[11例(14.9%)](P=0.005)。晕厥组心肌肥厚部位以室间隔肥厚为主者多见[15例(83.3%)];晕厥组室间隔的厚度[(2.18±0.24)cm]明显高于无晕厥组[(1.91±0.20)cm](P=0.000)。晕厥组快速性心律失常的发生例数[11例(61%)]明显多于非晕厥组[18例(24%)](P=0.003)。晕厥组QRS波的宽度[(0.107±0.020)s]明显大于无晕厥组[(0.094±0.018)s](P=0.009)。晕厥组的ST段下移超过0.1mV的例数[10例(55.6%)]明显多于无晕厥组[22例(29.7%)](P=0.039)。结论肥厚型心肌病患者中,晕厥者主要与流出道梗阻有关。晕厥以室间隔肥厚为主者多见,与室间隔的厚度相关,易发生快速性心律失常。晕厥者的心肌结构排列紊乱和心电紊乱可能更严重。

Objective To analyze clinical characteristics of syncope in patients with hypertrophic cardiomyopathy. Methods Ninety-two in-patients with hypertrophic cardiomyopathy （HCM） were enrolled. The diagnosis of HCM was based on 2-dimensional echocardiography. These patients who were divided into syncope group and non-syncope group were analyzed clinical characteristics, changes of electrocardiogram and the echocardiography. Results The syncope group had significantly high incidence of LV outflow obstruction than that of the non-syncope group （P=0.005）. Hypertro- phy in syncope group mainly confined to the ventricular septum and the thickness of ventricular septum in the syncope group were thicker than that in the non-syncope group （P=0.000）. Cases of tachycardia arrhythmia in the syncope group were more than that in the non-syncope group （P=0.003）. The electrocardiogram of syncope group had wider QRS duration than that of the non-syncope group （P=0.009）. The syncope group had more patients with ST-segment depression exceeding 0.1mV than non-syncope group （P=0.039）. Conclusions In patients with hypertrophic cardiomyopathy, syncope appears mainly in septal hypertrophic cardiomyopathy and is correlated with LV outflow obstruction. The incidence of syncope is correlated with the thickness of ventricular septum. The syncope group may have more severe cardiac muscle array and electrocardiographic turbulence.