肥厚型心肌病伴发晕厥的机制及其防治研究

The research about mechanism and prevention of accompanying syncope with hypertrophic cardiomyopathy

目的:探讨肥厚型心肌病(HCM)伴发晕厥的可能机制及其防治措施。方法:经皮介入治疗76例肥厚梗阻型心肌病(HOCM,梗阻组),术后口服ACEI/ARB,半年后改为以β受体阻滞剂为主治疗;LVOTPG<50 mm Hg或术中药物激发(PST)后<70 mm Hg的29例(对照组),一直以β受体阻滞剂为主治疗。观察:(1)对照组晕厥发生率与PST阳性率的差别;(2)对照组服药半年、1年晕厥发生率与入院时比较;(3)梗阻组术前、后晕厥发生率比较;(4)梗阻组术后半年晕厥发生率与对照组同期比较;(5)梗阻组术后1年晕厥发生率与对照组同期比较。结果:对照组PST阳性率高达55.5%;半年后其发生率明显下降(P<0.05);梗阻组病史中晕厥发生率明显低于对照组PST阳性发生率(P<0.05);梗阻组术后半年晕厥发生率与术前比较无明显下降(P>0.05);改服β受体阻滞剂半年后较前则显著下降(P<0.01)。结论:HOCM晕厥原因除梗阻外,还有神经反射参与;PST对筛选介入适应证、分析其机制及指导用药均有帮助;β受体阻滞剂对HCM伴发晕厥具有较好防治作用。

Objective To investigate the mechanism and prevention of syncope on patients with hypertrophic cardiomyopathy （HCM）. Methods Seventy-six cases of HOCM （obstruction group） were successfully operated by PTSMA and oral ACEI/ARB. After six months , they were treated with β-receptor blocker. Another 29 patients （control group） with LVOTPG 〈 50 mmHg or 〈 70 mmHg after pharmacologic stress test （PST）, have being treated with β-receptor blocker. The results was observed as follow： （1） the difference of between syncope incidence and positive incidence induced by PST in control group; （2） the difference of syncope incidence at half year, a year and admission in control group; （3） the difference of syncope incidence in obstruction group before and after operation; （4） the difference of syncope incidence after six months between two groups at same period; （5） the difference of syncope incidence one year between two groups. Results In control group, the syncope positive incidence induced PST was 55.5%. Treating with medications for half a year , syncope incidence significantly dropped than that on admission （P 〈 0.05）; Obstruction group syncope incidence in the history obviously lower than the control group syncope positive induced PST （P 〈 0.05）, and half a year after takingβ-receptor blocker syncope incidence was significantly dropped than before （P 〈 0.01）. Conclusions The mechanism of syncope with HOCM is not only obstruction but also neuronal reflex. PST is an very useful inspection item for screening the ablation indication, analysis syncope mechanism, and guiding clinical medication.β-receptor blocker is an effective drug on treating and preventing syncope with HCM.