改良扩大Morrow手术治疗肥厚型梗阻性心肌病术后合并症及预后分析  

Analysis for the Complication and Prognosis of Modified Extended Morrow Procedure in Patients With Hypertrophic Obstructive Cardiomyopathy

作　　者：张燕搏[1] 常硕[1] 王水云[2] 于钦军[3] 黄海波[1] 史晨[1] 蒙延海[1] 杨秋蓝[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心外科重症监护室,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心外科,北京市100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院麻醉科,北京市100037

出　　处：《中国循环杂志》2015年第6期520-524,共5页Chinese Circulation Journal

基　　金：国家自然科学基金(81400305);北京市自然科学基金(7142137);首都卫生发展科研专项基金(2011-4003-05);首都特色医疗专项基金(Z121107001012017)

摘　　要：目的：总结行改良扩大Morrow手术治疗肥厚型梗阻性心肌病（HOCM）术后主要合并症，探讨影响预后的主要因素。方法：回顾性分析2012-06至2014-07阜外心血管病医院由单一术者实施外科手术治疗的HOCM患者139例，男性87例、女性52例，年龄10～67（43.45±14.65）岁，体重26～105（66.46±13.94） kg，术前左心室流出道峰值压差（LVOTGP）为50~270（84.48±44.75）mmHg（1 mmHg=0.133 kPa）。全组均在全麻低温体外循环下行改良扩大Morrow手术，根据术前已知的心脏合并疾病，必要时同期行相应的手术治疗。围术期常规行心脏超声心动图、心电图及X线胸片检查，评价超声心动图检查指标、二尖瓣的结构和功能改变。随访1~24个月。结果：全组无围术期或远期死亡。本组单纯行改良扩大Morrow手术73例（73/139，53%），行改良扩大Morrow手术合并其他手术66例（66/139，47.5%），包括冠状动脉旁路移植术24例，二尖瓣成形术15例，二尖瓣置换术7例，三尖瓣成形术10例，主动脉瓣置换术2例，经胸心脏射频改良迷宫术3例，右心室流出道疏通2例，主动脉瓣下隔膜切除2例，室壁瘤切除术1例。全组机械通气时间8~396（24.05±36.74）h，术后住重症监护病房时间1~27（2.85±3.18）d，术后住院时间5~35（10.11±4.57）d，术后心律失常108例，胸腔积液25例，二次插管1例，气管切开1例，床旁血液滤过治疗1例，主动脉内球囊反搏1例，二次转入重症监护病房3例，无气胸、无二次开胸探查及二次手术。术后左心房内径、左心室流出道峰值压差、室间隔厚度、左心室射血分数与术前比较均减小或降低。二尖瓣关闭好或仅有轻度反流，二尖瓣前向运动基本消失。重症监护病房延时的主要因素为年龄≥55岁，体外循环时间≥120 min，升主动脉阻断时间≥90 min，合并心律失常以及合并右心功能不全。远期随访患者症Objective： To summarize the major post-operative complication of modiifed extended Morrow procedure in patients with hypertrophic obstructive cardiomyopathy （HOCM） and to explore the major factors affecting its prognosis. Methods： We retrospectively analyzed 139 consecutive HOCM patients who received the procedure by same surgeon in our hospital from 2012-06 to 2014-07. There were 87 male and 52 female patients with the age of （10-67） years, body weightof （26-105） kg and pre-operative left ventricular outlfow tract peak gradient （LVOTPG） of （84.48 ± 44.75） mmHg. Concomitant operations were performed with known cardiac disease as necessary. Pre- and post-operative echocardiography, ECG and chest X-ray were examined to assess the adequacy of resection and mitral valve structure and function. Results： There was no peri-operative death. 73/139 （53%） patients received simple modiifed expanded Morrow procedure, the other 66 （47%） patients received concomitant surgery including 21 patients with coronary artery bypass grafting, 15 mitral valve plasty, 7 mitral valve replacement, 10 tricuspid valve plasty, 2 aortic valve replacement, 3 modiifed Maze procedure, 2 unblock of right ventricular outlfow tract, 2 sub aortic membrane resection, 1 ventricular aneurysm resection. The mechanical ventilation time was （24.05±36.74） hours, post-operative ICU and in-hospital stays were （2.85±3.18） days and （10.11±4.57） days; the complications included arrhythmia in 108 cases, pleural effusion in 25 cases, secondary intubation in 1 case, tracheotomy in 1 case, hemoifltration in 1 case, intra-aortic balloon pump in 1 case, back into ICU in 3 cases; no pneumothorax, secondary thoracotomy/operation. The post-operative left atrial diameter, LVOTPG, inter-ventricular septal thickness and LVEF were all decreased; mitral valve closed well or with mild regurgitation, systolic anterior motion （SAM） basically disappeared. The major factors for delayed ICU stay included age≥55 years, female,

关 键 词：改良扩大Morrow手术 肥厚型梗阻性心肌病 并发症 预后 

分 类 号：R54[医药卫生—心血管疾病]