左心交感神经切除术治疗长QT综合征11例随访  

The follow-up observation of left cardiac sympathetic denervation surgery for treating 11 long QT syndrome patients.

作　　者：李翠兰[1] 胡大一[1] 王吉云[2] 刘文玲[1] 梅运清[2] 商利华[2] 马山[3] 马志敏[2] 

机构地区：[1]北京大学人民医院心内科,北京100044 [2]首都医科大学附属同仁医院心脏中心 [3]首都医科大学附属同仁医院胸外科

出　　处：《中国心脏起搏与心电生理杂志》2006年第1期21-24,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金(30170381);北京市科技新星计划(2004-BG-01)

摘　　要：目的 观察左心交感神经切除（LCSD）手术的方法对药物治疗无效的LQTS的疗效。方法 对11例LQTS患者行LCSD手术，术后定期进行心电图及临床症状的随访观察。结果 所有LCSD手术均成功，1例术后有Homer’s综合征。术后2±7天，24h动态心电图显示平均心率（HR）基本不变，最大HR由术前的103±14次／分略下降到术后的97±12次／分，而最小HR由43±5略升高到46±5次／分；运动试验中所能达到的最大HR明显下降，由术前的145±16次／分降低到术后的127±11次／分（P〈0．01，n=10）。随访16（14—25）个月，QTc值由术前的0．55±0．05下降到0．48±0．04s（P〈0．01，n=11）；同时发现手术后LQTS患者ECG上有顿挫T波变光滑的现象。随访期间1例有过3次短暂晕厥发作，其余患者皆无症状。结论 LCSD对药物不能控制的LQTS患者是一种安全、有效的疗法。Objective To investigate the effect of a surgical method of left cardiac sympathectomy for long QT syndrome （LQTS） patients resistant to medicines. Methods Left cardiac sympathetic denervation （LCSD）was performed in 11 LQTS patients. Patients＇ ECG and clinical symptoms were assessed before surgery and during follow-up. Results LCSD was successful in all patients. Homer＇s syndrome developed in 1 patient. During the day of 2-7 after surgery, the 24 h Holter monitoring ECG showed that the maximum heart rate（HR） decreased slightly from 103±14 bpm before to 97±12 bpm after surgery, and the minimum HR increased slightly from 43±5 before to 46 ±5 bpm after surgery. The exercise test showed that the maximum HR obtained during exercise could no longer reach the level before surgery for all patients, as it decreased from 145±16 bpm to 127±11 bpm （ P 〈 0.01, n = 10）. The 11 patients were followed up for 16 （ 14-25 ） months. QTc decreased from 0.55±0.05 s to 0.48±0.04 s （P 〈 0.01, n = 11 ）. Meanwhile, following QT shortening T wave was gradually become smoother rather than bifid. All patients were symptom free except one who had 3 syncopes during morning sleep. Conclusions Our direct observations are consistent with the safety and efficacy of LCSD for LQTS patients observed by other investigators.

关 键 词：心血管病学 长QT综合征 左心交感神经切除术 校正的QT间期 运动试验 T波 

分 类 号：R541.7[医药卫生—心血管疾病] R654.2[医药卫生—内科学]