肥厚型心肌病患者的围术期管理

Perioperative Management of Patients with Hypertrophic Cardiomyopathy Undergoing Surgical Operation

肥厚型心肌病(HCM)患者围术期循环系统的不稳定性给麻醉及手术实施带来诸多挑战。大部分HCM患者无明确临床表现,临床中很可能会遇到未被诊断的HCM患者,麻醉医师应充分掌握HCM的临床表现、病理生理机制以及触发或加重左心室流出道梗阻的危险因素。术中经食管超声心动图有助于明确诊断、识别二尖瓣瓣膜形态及结构的异常、区分术中低血压的原因,进而指导治疗。HCM患者围术期风险高、管理难度大,因此探讨肥厚型心肌病患者行心脏手术及非心脏手术的围术期管理要点具有重要临床意义。

The perioperative circulatory system instability of patients with hypertrophic cardiomyopathy(HCM) poses many challenges regarding the conduct of anesthesia and surgery.Most patients affected by this disease have no clear clinical symptoms,and anesthetists may be confronted with clinically unrecognized HCM and must have a complete understan- ding of the relevant pathophysiology,clinical presentation and mechanisms that may trigger or accentuate dynamic left ventricle outflow tract obstruction.Intraoperative transesophageal echocardiography examination confirms the diagnosis,identifies morphological and structural abnormalities of mitral valve,distinguishes the causes of intraoperative hypotension and guides the treatment.The perioperative risk of patients with HCM is high and difficulty to manage,therefore,exploring the periope- rative management of patients with HCM presenting for cardiac surgery or non-cardiac surgery has great clinical significance.