不同猝死风险的肥厚型心肌病合并房颤患者射频消融术后预后的影响因素分析

A Study on the Prognostic Factors of Patients of Hypertrophic Cardiomyopathy with Atrial Fibrillation of Different Risk of Sudden Death

【目的】通过研究不同猝死风险的肥厚型心肌病（HCM）合并房颤患者射频消融术预后的危险因素,旨在为临床采用射频消融术治疗不同猝死风险HCM合并房颤患者提供参考。【方法】收集并分析2012年至2015年在本院进行AF导管射频消融治疗的90例HCM 患者。按5年猝死风险评估分为高风险组27例,低风险组43例（剔除AF相同类型者20例）,经过（3.14±1.53）年的随访,比较两组患者预后的危险因素。【结果】70例患者中共有6例患者死亡,占到总数的8.5%。其中有4名患者死于心源性猝死,有2例患者为非心源性死亡,并且有12例患者出现心源性再住院。在COX比例风险模型分析中,低风险组的生存率明显高于高风险组,同时结果显示,对于高风险组hs-CRP和左室射血分数是其患者术后存活的影响因素,而低风险组主要危险因素是年龄。【结论】在临床治疗时,对于高猝死风险患者,要严密监测患者血hs-CRP值,同时根据患者左室射血分数加强患者术后护理。

【Objective】To study the prognostic factors of patients with hypertrophic cardiomyopathy with atrial fibrillation of different risk of sudden death, so as to provide a reference for the treatment of HCM with atrial fibrillation with different risk of sudden death by radiofrequency ablation.【Methods】A total of 90 patients with HCM underwent AF catheter radiofrequency ablation from 2012 to 2015 were collected and analyzed. According to the 5-year risk assessment of sudden death, 27 cases were assigned into high risk group and 43 cases in low risk group （20 cases were excluded due to the same type of AF）. All of them were followed up for （3.14 ±1.53） years, and the risk factors of prognosis between the two groups were compared.【Results】In 70 patients, 6 patients died, accounting for the total number of 8.5%, 4 of whom died of sudden cardiac death, 2 were non cardiogenic, and 12 had cardiogenic rehospitalization. In the COX scale risk model, the survival rate of the low risk group was significantly higher than that of the high risk group, and the results also showed that hs-CRP and left ventricular ejection fraction （LVEF） were the main risk factors for postoperative survival in the high risk group, while age was the main risk factor in the low risk group.【Conclusion】During clinical treatment, the hs-CRP value of patients with high risk of sudden death should be closely monitored and the postoperative nursing care should be strengthened according to the value of left ventricular ejection fraction （LVEF）.