女性肥厚型梗阻性心肌病化学消融围术期并发症及临床疗效

Multivariate Logistic analysis of risk factors for related complications of chemical ablation on female hypertrophic obstructive cardiomyopathy and the immediate effectiveness

目的:总结女性肥厚型梗阻性心肌病(HOCM)行经皮室间隔心肌化学消融术(PTSMA)治疗的疗效及安全性。方法:入选2000-01-2015-04实施PTSMA治疗的女性患者的临床资料和化学消融结果,总结绝经后女性和未绝经女性HOCM患者行PTSMA的术中、术后围术期并发症的发生情况及住院期间临床疗效,探讨女性HOCM患者行PTSMA的疗效及安全性。结果:107例女性HOCM患者中共106例接受PTSMA治疗,术后比术前静息及期前收缩后左心室流出道压力阶差明显下降[(17.76±22.42)mmHg∶(74.28±38.03)mmHg,P=0.000;(38.70±21.04)mmHg∶(117.48±39.75)mmHg,P=0.000],差异均有统计学意义。绝经后女性共72例,其中71例接受PTSMA治疗,术后比术前静息及期前收缩后左心室流出道压力阶差明显下降[(17.19±20.38)mmHg∶(75.49±37.51)mmHg,P=0.000;(40.44±23.27)mmHg∶(120.98±37.28)mmHg,P=0.000],差异均有统计学意义。未绝经女性共35例,术后比术前静息及期前收缩后左心室流出道压力阶差亦明显下降[(18.97±26.64)mmHg∶(71.65±39.63)mmHg,P=0.000;(33.74±11.92)mmHg∶(107.21±43.03)mmHg,P=0.000],差异均有统计学意义。两组术前后静息及早搏后左心室流出道压力阶差变化值无明显变化[△(58.37±30.36)mmHg∶△(52.68±27.06)mmHg,P=0.374;△(83.21±32.07)mmHg∶△(74.00±38.70)mmHg,P=0.313],两组无水酒精用量无统计学差异[(1.83±0.70)ml∶(1.89±0.74)ml,P=0.697]。术中及术后绝经后女性较严重并发症发生率明显高于未绝经女性(23.61%∶5.71%,P=0.035),但Logistic回归分析显示,是否绝经并非较严重并发症的独立危险因素。结论:女性HOCM患者无论是否绝经行PTSMA治疗均是有效的。绝经的患者较严重并发症发生率较高,但绝经并非独立的危险因素。

Objective：To retrospectively investigate the curative effects and the complication of female patients with hypertrophic obstructive cardiomyopathy（HOCM）treated by percutanous transluminal septal myocardial ablation（PTSMA）.Method：Retrospectively analyzed the data from patients with HOCM treated by PTSMA from Jan.2000 to Apr.2015,including in clinical data,and the results of PTSMA to assess the complication and immediate results of female HOCM patients in hospital.Result：There were 106 female patients received PTSMA among all 107 female patients with HOCM.Left ventricular outflow tract pressure gradient（LVOTPG）dropped apparentely after operation[（17.76±22.42）vs（74.28±38.03）mmHg,P=0.000;（38.70±21.04）vs（117.48±39.75）mmHg,P=0.000）.There were 71post-menopausal female patients received PTSMA among all 72 postmenopausal female patients with HOCM.Left ventricular outflow tract pressure gradient（LVOTPG）dropped apparentely after operation[（17.19±20.38）vs（75.49±37.51）mmHg,P=0.000;（40.44±23.27）vs（120.98±37.28）mmHg,P=0.000）.There were 35 premenopausal female patients received PTSMA.Left ventricular outflow tract pressure gradient（LVOTPG）dropped apparentely after operation[（18.97±26.64）vs（71.65±39.63）mmHg,P=0.000;（33.74±11.92）vs（107.21±43.03）mmHg,P=0.000）.The changing value of LVOTPG were similar between 2groups（△58.37 ±30.36vs△52.68±27.06,P=0.374;△83.21±32.07vs△74.00±38.70,P=0.313）.The severe complication rate was higher in post-menopausal female groups（23.61% vs 5.71%,P=0.035）,but multivariate Logistic analysis showed post-menopausal was not independent risk factors.Conclusion：The PTSMA for HOCM is an effective treatment for post-menopausal and premenopausal patients.Post-menopausal is not an independent risk factor.