间隔化学消融术治疗肥厚型梗阻性心肌病  

Clinical Evaluation of Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy

作　　者：林瑾仪[1] 钱菊英[1] 葛均波[1] 王齐兵[1] 樊冰[1] 严卫[1] 葛雷[1] 刘学波[1] 张峰[1] 舒先红[1] 潘翠珍[1] 程蕾蕾[1] 崔洁[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所,上海200032

出　　处：《中国临床医学》2009年第1期31-33,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察经皮腔内间隔心肌化学消融术(percutaneous transluminal septal myocardial ablation,PTSMA)治疗药物难治性肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)的疗效,分析疗效与消融血管的选择、无水乙醇用量之间的关系。方法:对21例HOCM药物疗效欠佳的患者进行PTSMA治疗,其中男性14例,女性7例。消融术前后心导管测量左室流出道压差(left ventricular outflow-tract gradients,LVOTG)。结果:15例手术成功,消融术前后心导管测压LVOTG分别为73.7±32.2mmHg和32.0±26.1mmHg(P<0.01)。单支血管消融术和多支血管消融术疗效相当,但多支血管消融使术后心肌肌钙蛋白cTnT和肌酸激酶同工酶CK-MB进一步升高(P=0.02和P=0.03)。以无水乙醇用量为横坐标,LVOTG下降为纵坐标做图,当用量在1.5～2.5mL及4mL左右时,LVOTG下降达高峰。线性相关回归分析显示,术后cTnT峰值(y)与无水乙醇用量(x)相关(r=0.526,P<0.05)。结论:PTSMA治疗HOCM患者的疗效满意,确定靶血管是关键,建议消融单支靶血管的无水乙醇用量以1.5～2.5mL为宜。Objective：To observe the efficacy of percutaneous transluminal septal myocardial ablation （PTSMA） in drug-refractory hypertrophic obstructive cardiomyopathy（HOCM）, and to evaluate the impact of the number of target-vessel and the dose of absolute ethanol on the efficacy. Methods： PTSMA was performed in 21 patients （male 14, female 7） with symptomatic drug-refractory HOCM, left ventricular outflow-tract gradient（LVOTG） was measured before and after the procedure. Results： Procedure success was achieved in 15 patients. The average LVOTG was 73.7 ± 32.2 mmHg before the procedure, and 32.0 ± 26. 1 mmHg after the procedure,P〈0.01. The efficacy was comparable between the group of single target-vessel and multiple target vessel, yet multiple target-vessel ablation elevated cTnT and CK-MB more compare to single target-vessel ablation（ P= 0. 02 and P= 0.03）. Make a graph with the dose of absolute ethanol as X-axis and the reduction in LVOTG as Y-axis, the graph showed that when the dose of absolute ethanol within the range of 1.5-2.5 mL and close to 4 mL, LVOTG decrease to the most extent. Linear correlation and regression analysis showed that peak value of cTnT after PTSMA（y） was correlated with the dose of absolute ethanol（r = 0. 526,P〈0.05）. Conclusion： PTSMA is effective for symptomatic patients with HOCM. To determine the target-vessel is the key point. In single target-vessel ablation 1.5-2.5 ml is the optimal dose of absolute ethanol.

关 键 词：肥厚型心肌病 导管消融术 

分 类 号：R542.2[医药卫生—心血管疾病]