摘要
目的评价用无水酒精作经皮心室间隔心肌化学消融（下称化学消融）治疗肥厚型梗阻性心肌病的即刻疗效和术中心律失常的发生情况。方法观察31例肥厚型梗阻性心肌病患者化学消融前后左心室流出道压差的变化。结果手术成功28例（成功率90．3％），所有患者化学消融后左心室流出道压差[（30．5±23．3）mmHg]较化学消融前[（74．5±31．9）mmHg]降低，差异有显著统计学意义（P〈0．01）。有间隔支收缩期挤奶现象者行单支间隔支化学消融成功率（100％）较无此现象者（26．1％）提高，差异有显著统计学意义（P〈0．01）。单支血管化学消融致左心室流出道压差下降程度[（46．5±20．7）mmHg]与多支血管消融[（41．6±18．9）mmHg]差异无统计学意义（P〉O．05）。化学消融术中发生一度房室传导阻滞1例，酒精用量3．0ml；三度房室传导阻滞4例，酒精用量平均4．3ml；室性期前收缩伴ST-T改变2例。酒精用量平均为3．3ml。结论化学消融治疗肥厚型梗阻性心肌病患者疗效满意，伴有收缩期挤奶现象的化学消融可作为靶血管首选，化学消融多支血管仅作为化学消融单支血管疗效不满意时的补充。术中出现心律失常似与无水酒精用量较多有关，应尽可能减少用量。
Objective To evaluate the immediate efficacy of percutaneous septal myocardial alcohol ablation （PSMAA） in patients with hypertrophic obstructive cardiomyopathy （HOCM） and associated arrhythmias. Methods The left ventricular outflow tract gradient （LVOTG） was assessed before and after PSMAA in 31 patients with HOCM Results PSMAA was successful in 28 cases （90.3%）. LVOTG significantly decreased from 74.5 ± 31.9mmHg before to 30.5± 23.3mmHg after PSMAA （P 〈 0.01）. The success rate was significantly higher in patients with（ 100% ）than without （ 26.1% ） milking effect of septal branch during systole （P〈0.01）. There was no significant difference in LVOTG reduction between single-vessel[（46.5 ± 20.7 ）mmHg] and multivessel [（41.6 ±18.9）mmHg] ablation （P〉0.05）. The volume of absolute alcohol used was 3 ml in one case developed grade I atrioventricular block, while it was mean 4.3 ml in 4 cases developed grade Ⅲ atrioventricular block and 3.3ml in 2 patients with premature ventricular contractions and ST-T changes during PSMAA.. Conclusion PSMAA is effective in the treatment of HOCM. The septal branch with systolic compression is the optimal vessel for PSMAA. Multi-vessel ablation can be performed only when the efficacy of single-vessel ablation is not ideal. The amount of alcohol seems to be related to arrhythmias and should be kept as low as possible.
出处
《心电与循环》
2012年第1期14-15,35,共3页
Journal of Electrocardiology and Circulation
