原发性肥厚型梗阻性心肌病患者室间隔化学消融的疗效及围术期并发症相关危险因素

The curative effect of percutaneous transluminal septal myocardial ablation and the related risk factors of perioperative complications in patients with hypertrophic obstructive cardiomyopathy

目的:总结原发性肥厚型梗阻性心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗并发症的发生情况,探讨其相关危险因素。方法:入选实施PTSMA治疗的HOCM患者237例,对其临床资料和化学消融结果进行分析,总结PTSMA术中、术后围术期并发症的发生情况及18个月临床随访情况。结果:术后静息及期前收缩后左心室流出道压力阶差较术前明显下降[静息:(15.78±18.80)mmHg︰(67.02±36.87)mmHg;期前收缩后:(40.09±22.40)mmHg︰(119.02±39.80)mmHg;均P<0.01]。Logistic多因素回归分析显示,高血压为严重并发症(包括死亡、心肌梗死、Ⅲ度房室传导阻滞、心室颤动、休克、急性左心衰竭、股动脉假性动脉瘤)独立的相关危险因素(r=3.610,P=0.008)。18个月临床随访:21例胸闷、气促症状复发,20例经强化药物治疗后好转,1例症状无明显改善再次行化学消融治疗后好转;1例心力衰竭急性加重死亡。结论:化学消融治疗HOCM临床有效,但高血压是HOCM患者行PTSMA的独立危险因素。部分术后症状复发的病例,经强化药物治疗大部分症状缓解,症状不缓解者可行二次化学消融,仍可取得明显疗效。

Objective：To explore the postoperative complications and related risk factors of percutaneous transluminal septal myocardial ablation（PTSMA）treatment in patients with hypertrophic obstructive cardiomyopathy（HOCM）.Method：A total of 237 HOCM patients underwent PTSMA treatment were included,the occurrence of perioperative complications and outcomes of follow-up for 18 months were analyzed.Result：The resting and postpremature ventricular outflow tract pressure gradient after PTSMA were decreased significantly compared with those before the operation[resting：（15.78±18.80）mmHg vs.（67.02±36.87）mmHg;post-premature：（40.09±22.40）mmHg vs.（119.02±39.80）mmHg;both P〈0.01].Logistic regression analysis showed that hypertension was an independently associated risk factor for severe complications（including death,myocardial infarction,Ⅲ degree atrioventricular block,ventricular fibrillation,shock,acute left ventricular failure and femoral artery pseudoaneurysm）（r=3.610,P=0.008）.The results of followed up for 18months：21cases had recurrence of chest pain and shortness of breath,20 cases improved after intensive drug treatment and one case improved after ablation again.One cases died of acute heart failure.Conclusion：PTSMA is effective in the treatment of HOCM,and hypertension is an independent risk factor.In some cases with recurrence of symptoms,the majority are improved using intensive drug treatment,and re-PTSMA could still achieve obvious curative effect.