单中心室间隔心肌切除术治疗肥厚型梗阻性心肌病中远期结果分析  

Medium—long Term Outcomes of Ventricular Septal Myectomy for Treating the Patients With Hypertrophic Obstructive Cardiomyopathy—A Single Center Experience

作　　者：李浩杰[1] 宋云虎[1] 朱晓东[1] 胡盛寿[1] 郑哲[1] 王水云[1] 孙寒松[1] 王巍[1] 许建屏[1] 熊辉[1] 王欣[1] 闫军[1] 王小啟[1] 刘赟[1] 然鋆[1] 唐亚捷 

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医院成人心脏外科,北京市100037

出　　处：《中国循环杂志》2016年第6期573-577,共5页Chinese Circulation Journal

摘　　要：目的：分析室间隔心肌切除术治疗肥厚型梗阻性心肌病的中远期生存率,并分析中远期结果的预测因子。方法：连续入选1984-10至2014-12在阜外医院行室间隔心肌切除术的655例肥厚型梗阻性心肌病患者。由心血管病专业护士对患者进行问卷调查随访。结果：手术死亡率为1.4%（9例/655例）。平均随访（30.8±30.9）个月（3~213个月）,52例（7.9%）患者失访,583例（96.7%）患者NYHA心功能分级Ⅰ或Ⅱ级。1年、5年、8年生存率分别为98.3%、90.5%、88.3%。80例患者发生终点事件（肥厚型心肌病相关性死亡、因缺血性脑卒中、快速心律失常、心肌缺血或心肌梗死和心力衰竭再住院、心脏移植、再次心肌切除和永久起搏器植入）,1年、5年、8年终点事件免除率分别为94.2%、76.7%、65.9%。多因素Cox回归分析显示年龄〉50岁[风险比（HR）=2.16,95%可信区间（CI）：1.36~3.46,P=0.001]和术前心房颤动[HR=2.31,95%CI：1.35~3.94,P=0.002）]是终点事件的独立预测因子。结论：肥厚型梗阻性心肌病患者行室间隔心肌切除术后可获得良好的中远期生存率,不良事件发生率低。年龄〉50岁和术前心房颤动是不良事件的独立预测因子。Objective： To report the medium-long term survival rates of ventricular septal myectomy for treating the patients with hypertrophic obstructive cardiomyopathy and to analyze the predictive factors affecting the outcomes. Methods： A total of 655 consecutive patients who received ventricular septal myectomy in our hospital from 1984-10 to 2014-12 were retrospectively summarized. The cohort study was conducted with questionnaires by cardiovascular nurses. Result： The operative mortality was 1.4% （9/655）. The mean follow-up time was （30.8 ± 30.9, from 3 to 213） months, there were 52/646 （7.9%） patients lost contact and 583 patients having NYHA classification at I or II during that period. The overall survival rates for 1 year, 5-year and 8-year were 98.3%, 90.5% and 88.3% respectively. There were 80 patients suffered from end point events including HCM-related death, heart transplantation, repeated myectomy, permanent pacemaker implantation and re-admission for ischemic stroke, tachyarrhythmia, myocardial ischemia or infarction, congestive heart failure. The end point events free survival rates for 1 year, 5-year and 8-year were 94.2%, 76.7% and 65.9% respectively. Multivariable Cox regression analysis presented that age〉50 years （HR=2.16, 95% CI 1.36-3.46, P=-0.001） and pre-operative atrial fibrillation （FA） （HR=2.31, 95% CI 1.35-3.94, P=-0.002） were the independent predictors for end point events occurrence. Conclusion： Ventricular septal myectomy may achieve good medium-long term survival rate with less adverse eventin patients with hypertrophic obstructive cardiomyopathy. Elder than 50 years of age and with pre-operative FA were the independent predictors for adverse events occurrence.

关 键 词：心肌病 肥厚型 室性流出道阻塞 外科 存活率 

分 类 号：R541[医药卫生—心血管疾病]