经皮室间隔心肌化学消融酒精用量对围手术期心肌损伤和心律失常的影响  

Effects of varying alcohol dosing in percutaneous septal ablation for obstructive hypertrophic cardiomyopathy on myocardial infarct size and arrhythmias within peri-interventional period

作　　者：杨吉猛[1] 王晖[1] 徐东杰[1] 吴恒芳[1] 朱铁兵[1] 王连生[1] 戴振华[1] 杨迪[1] 杨志健[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,南京210029

出　　处：《临床心血管病杂志》2013年第3期197-200,共4页Journal of Clinical Cardiology

基　　金：江苏省兴卫工程重点学科开放课题(No:XK05200902;XK05200903)

摘　　要：目的:探讨经皮室间隔心肌化学消融(PTSMA)酒精用量与围术期心肌损伤和心律失常发生的关系。方法:连续选择接受低剂量酒精(≤2ml)消融的肥厚型梗阻性心肌病(HOCM)患者10例(低剂量组),从资料库中筛选常规较大剂量酒精(>2ml)治疗的患者20例作为对照组,分别记录两组患者围术期血清肌酸激酶同工酶(CK-MB)峰值及心律失常的发生情况,同时评估两种剂量酒精对术后血流动力学和心脏结构的影响。结果:低剂量组和对照组PTSMA围术期CK-MB峰值分别为(126.9±55.3)U/L和(232.8±58.7)U/L(P<0.01);相关分析显示,CK-MB峰值与酒精剂量呈显著正相关(r=0.646,P<0.01);两组发生急性房室传导异常(含束支、室内传导和Ⅰ～Ⅲ度房室传导阻滞)分别为6例(60%)和13例(65%),发生Ⅲ度房室传导阻滞分别为2例(20%)和5例(25%);两组术后左心室流出道压力阶差(LVOTPG)和室间隔厚度较基线水平均显著下降(均P<0.01),但两组间术后LVOTPG水平及下降幅度均差异无统计学意义。结论:低剂量酒精能减少PTSMA围术期心肌坏死,并显著改善术后血流动力学和心脏结构,但不能减轻传导系统的损伤。Objective：To evaluate the beneficial effects of low-dose alcohol in pecutaneous transluminal septal myocardial ablation （PTSMA） for obstructive hypertrophic cardiomyopathy （HOCM）. Method：A 1 ： 2 matched case-control study was performed in our hospital. 10 consecutive patients with HOCM received a small amount of alcohol （42 ml）, and they were compared with 20 cases receving standard dose （〉2 ml）. Early results of myocardial infarct size and arrhythmias within perioperative period were determined by peak CK MB and electrocardiogram. The resultant hemodynamic changes and left ventricular remodeling were also checked. Result：The CK-MB peak within peri-interventional period were （126.9±55.3）U/L and （232.8±58.7）U/L （P〈0.01）. There was a significant correlation between peak CK-MB and alcohol dose （r=0. 646, P〈0.01）. Acute abnormalities in conduction system occurred in 6 patients （60%） from low-dose group and 13 patients （65%） from control group. Temporary post procedural complete atrioventricular block was identified in 2 patients （20 % ） from low-dose group and 5 patients （25 % ） from control group. Post-procedural LVOTPG and interventricular septum decreased significantly （P〈0.01）. But there was no significant difference in the level of Post procedural I.VOTPG and decreasing amplitude between the 2 groups. Conclusion：Low dose of alcohol minimize the myocardial infarct size, but can not eliminate or lower the occurrence of arrhythmias （mostly atrioventricular abnormalities） during the peri-interventional period.

关 键 词：心律失常 经皮室间隔心肌化学消融 酒精用量 心肌损伤 

分 类 号：R541.7[医药卫生—心血管疾病]