肥厚型梗阻性心肌病42例化学消融疗效观察

Efficacy of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy:an analysis of 42 cases

目的探讨肥厚型梗阻性心肌病患者化学消融治疗的疗效。方法收集2012年至2016年在广东省人民医院行经皮室间隔化学消融术(percutaneous transluminal septal myocardial ablation,PTSMA)的肥厚型梗阻性心肌病患者42例,比较患者术中消融前、后左心室流出道压差(left ventricular outflow tract pressure gradient,LVOTPG),患者术前、术后1周、术后半年的LVOTPG、室间隔厚度、左心房内径(left atrial diameter,LAD)、最厚室壁厚度、射血分数。观察患者并发症发生情况及临床症状改善情况。结果(1)患者术中消融后LVOTPG与消融前比较显著降低,差异有统计学意义[(41.0±30.8)mmHg vs.(111.4±37.5)mmHg,P<0.05;1 mm Hg=0.133kPa]。(2)术后1周LVOTPG与术前相比有所减少,差异有统计学意义[(58.8±40.9)mmHg vs.(105.6±42.7)mmHg,P<0.05];术后半年LVOTPG与术后1周相比,差异无统计学意义[(53.3±40.3)mmHg vs.(58.8±40.9)mmHg,P>0.05]。(3)术后1周室间隔厚度、最厚室壁厚度与术前比较,差异无统计学意义(P>0.05);术后半年与术前、术后1周比较,有所减少,差异有统计学意义[室间隔厚度:(18.5±5.4)mmHg vs(.19.5±4.4)mmHg vs.(18.9±4.2)mmHg,P<0.05;最厚室壁厚度:(19.2±4.1)mmHg vs(.20.9±4.9)mmHg vs(.20.4±4.3)mmHg,P<0.05]。(4)术前、术后1周、术后半年射血分数、LAD比较,差异无统计学意义(P>0.05)。(5)术后半年内,患者呼吸困难、黑朦、乏力等症状明显减少,手术并发症相对较少。结论在肥厚梗阻性心肌病的治疗中,化学消融能在短期内显著降低跨LVOTPG,长期能减少室间隔及最厚室壁厚度,改善患者临床症状及预后,治疗效果肯定。

ObjectivesTo study the curative effect of patients with hypertrophic obstructive cardiomyopathy（HOCM）underwent percutaneous transluminal septal myocardial ablation（PTSMA）.MethodsTotally 42 patients with HOCM underwent PTSMA in Guangdong General Hospital between 2012 and 2016 were included in this study.Left ventricular outflow tract pressure gradient（LVOTPG）,thickness of interventricular septum（IVS）,left atrial diameter（LAD）,the thickest ventricular wall（TVW）,ejection fraction（EF）were compared before operation and 1 week,half a year after operation.Differences of complications and clinical symptoms were observed.Results（1）LVOTPG of patients just after PTSMA significantly decreased comparing with that just before PTSMA[（41.0±30.8）mmHg vs.（111.4±37.5）mmHg,P〈0.05;1mmHg=0.133 kPa].（2）LVOTPG of patients 1 week after PTSMA significantly decreased comparing with that before PTSMA[（58.8±40.9）mmHg vs.（105.6±42.7）mmHg,P〈0.05];LVOTPG of patients half a year after PTSMA had no significant difference with that of patents 1 week after PTSMA[（53.3±40.3）mmHg vs.（58.8±40.9）mmHg,P〉0.05].（3）IVS,TVW of patients 1 week after PTSMA had no significant differences with those of patients before PTSMA（P〉0.05）;IVS,TVW of patients half a year after PTSMA decreased comparing with those of patients before PTSMA and 1 week after PTSMA[IVS：（18.5±5.4）mmHg vs.（19.5±4.4）mmHg vs.（18.9±4.2）mmHg,P〈0.05;TVW：（19.2±4.1）mmHg vs.（20.9±4.9）mmHg vs.（20.4±4.3）mmHg,P〈0.05].（4）EF and LAD of patientsbefore PTSMA,1 week after PTSMA,half a year after PTSMA had no significant differences（P〉0.05）（5）After half a year,dyspnea,fatigue and other symptoms of patients obviously reduced,with few complications happened.Conclusions PTSMA can significantly reduce LVOTPG in short term,reduce IVS,TVW in long term in patients with HOCM.It can improve the prognosis of patients and the treatment effect is positive.