肥厚型梗阻性心肌病外科治疗的疗效分析

Analysis of the effect of surgical treatment for hypertrophic obstructive cardiomyopathy

目的评价外科治疗肥厚型梗阻性心肌病的疗效。方法回顾性分析2016~2018年期间于武汉科技大学附属武汉亚洲心脏病医院行改良扩大Morrow术的84例患者临床资料,年龄为(51.05±11.93)岁,其中男性52例(61.90%)。术前左心室流出道峰值压差(LVOT-PG)为(82.95±36.26)mmHg(1mmHg=0.133kPa)。结果术中主动脉阻断时间为(49.73±22.74)min;体外循环时间为(103.39±39.98)min;术后住重症监护室(ICU)时间为(158.24±42.60)h;术后住院时间为(12.24±2.62)d。超声心动图手术前后参数对比:左心房内径(LA)大小变化[(4.57±0.68)cm vs.(3.68±0.64)cm],室间隔厚度(IVS)变化[(2.31±0.48)cm vs.(1.76±0.48)cm],左心室流出道峰值压差(LVOT-PG)变化[(82.95±36.26)mmHg vs.(17.18±10.53)mmHg]均有显著降低,差异具有统计意义(P<0.05);左心室流出道宽度(LVOT diameter)变化[(1.18±0.37)cm vs.(1.93±0.28)cm]有所增加(P<0.05)。左心室射血分数术前术后无明显变化(P>0.05),术后二尖瓣反流情况改善或轻度反流,收缩期前向运动消失。2例患者术后早期死于多器官衰竭。结论改良扩大Morrow手术短期内即可有效解除流出道梗阻,缓解症状,提高生活质量和预后。

Objectives To evaluate the effect of surgical treatment for hypertrophic obstructive cardiomyopathy.Methods To retrospectively analyze the clinical data of consecutive 84 patients who underwent modified Morrow surgical operation in Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology from 2016 to 2018,whose average of age was(51.05±11.93)years,including 52(61.90%)men.The maximum pressure gradient of left ventricular outflow tract(LVOT-PG)before operation was(82.95±36.26)mmHg(1 mmHg=0.133 kPa).All the patients received modified Morrow surgical operation in our hospital,and the preoperative and postoperative indexes of the patients were collected to evaluate the curative effect of the operation.Results The duation of aortic occlusion during operation were(49.73±22.74)minutes.The cardiopulmonary bypass(CPB)duation were(103.39±39.98)minutes.The postoperative stay in intensive care unit(ICU)were(158.24±42.60)hours,and the postoperative stay in hospital were(12.24±2.62)days.Comparison of parameters before and after operation:left atrium(LA)diameter[(4.57±0.68)cm vs.(3.68±0.64)cm],interventricular septum(IVS)thickness[(2.31±0.48)cm vs.(1.76±0.48)cm],and the pressure gradient of left ventricular outflow tract(LVOT-PG)[(82.95±36.26)mmHg vs.(17.18±10.53)mmHg]decreased significantly.The differences were statistically significant(P<0.05).Left ventricular outflow tract diameter(LVOT diameter)[(1.18±0.37)vs.(1.93±0.28)cm]increased slightly(P<0.05).However,there was no significance in LVEF before and after operation(P>0.05).After operation,mitral regurgitation improved or only mild regurgitation and systolic anterior motion disappeared.Two patients died of multiple organ failure in the early stage after operation.Conclusions Modified extended Morrow surgical operation could dredge effectively left ventricular outflow tract ob⁃struction in a short period of time,relieve symptoms and improve quality of life and prognosis.