肥厚梗阻型心肌病化学消融术酒精用量对术后早期血流动力学和心脏重构的影响

Effects of low-dose alcohol in pecutaneous transluminal septal myocardial ablation for obstructive hypertrophic cardiomyopathy on early hemodynamics and left ventricular remodeling

目的:探讨经皮室间隔心肌化学消融术(PTSMA)最适酒精使用剂量。方法:连续选择2007年1月～2010年12月在本院接受低剂量酒精(≤2.0 ml)消融的肥厚梗阻型心肌病(HOCM)患者10例;按1∶2配比的病例对照研究,选择2000年1月～2006年12月接受较大剂量酒精(>2.0 ml)消融治疗的患者20例作为历史对照组,分别评估两种治疗方案对术后早期血流动力学和心脏重构的影响。结果:低剂量和对照组术后即刻[(28.0±8.8)mmHg和(27.5±7.2)mmHg]、术后3个月[(29.5±6.6)mmHg和(28.1±5.0)mmHg]的左心室流出道压力阶差(LVOTPG)均较基线时[(69.9±13.1)mmHg和(70.6±13.4)mmHg]显著性下降(P<0.01),术后室间隔厚度明显减小(P<0.01),左心室舒张末内径无变化;而两组间术后即刻、术后3个月LVOTPG水平及下降幅度均无差异(P>0.05);相关分析显示,酒精用量分别与术后即刻LVOTPG以及术后3个月LVOTPG、室间隔厚度和左室舒张末内径等变化无相关性(P>0.05)。结论:小剂量酒精消融同样导致术后早期血流动力学和心脏结构的改善。

Objective： To determine the effects of various doses of alcohol in pecutaneous transluminal septal myocardial ablation（PTSMA） for obstructive hypertrophic cardiomyopathy（HOCM）.Methods： A 1∶2 matched case-control study was performed in our hospital.Ten consecutive patients with HOCM were assigned to receive small dose of alcohol（≤2.0 ml）,and they were compared with 20 cases receiving standard doses（ 2.0 ml）.Early results of hemodynamic changes and left ventricular remodeling were determined invasively and by echocardiography before and after PTSMA.Results： In low-dose alcohol group,left ventricular outflow tract pressure gradient（LVOTPG） was（28.0 ± 8.8） mmHg immediately after PTSMA（P 0.01）,and（29.5 ± 6.6） mmHg at 3 months（P 0.01）,versus（69.9 ± 13.1） mmHg before the procedure.In standard group,LVOTPG was（27.5 ± 7.2） mmHg immediately and（28.1 ± 5.0） mmHg at 3 months after PTSMA（P 0.01）,vs（70.6 ± 13.4） mmHg before the procedure.The thickness of interventricular septum（IVS） was significantly decreased at 3 months post-PTSMA in both groups（P 0.01）.However,there were no significant differences in hemodynamic and morphologic changes between the 2 groups after PTSMA.No significant correlations were identified between the volume of ethanol injected and early hemodynamic,morphologic variables immediately or at 3 months after PTSMA either in low or standard dose of alcohol.Conclusion： Low-dose of alcohol was able to achieve the desirable degree of LVOTPG reduction and left ventricular remodeling in PTSMA.