改良扩大Morrow手术治疗青少年肥厚型梗阻性心肌病患者的早期疗效分析  

Surgical Management of Hypertrophic Obstructive Cardiomyopathy in 29 Adolescent Patients

作　　者：朱昌盛[1] 陈海波[1] 王水云[1] 于钦军[1] 王婧金 肖明虎[1] 崔颢[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心血管疾病国家重点实验室,北京市100037

出　　处：《中国循环杂志》2016年第6期583-587,共5页Chinese Circulation Journal

基　　金：国家自然科学基金(81570276);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:评价改良扩大Morrow手术(室间隔心肌切除术)治疗青少年肥厚型梗阻性心肌病(HOCM)的早期手术疗效。方法:回顾性分析我院2011年至2015年改良扩大Morrow手术治疗29例青少年(≤21岁)HOCM患者的临床资料,评价早期手术疗效。术前、术后超声心动图检查比较左心房前后径、左心室舒张末期内径、左心室射血分数、室间隔厚度、左心室流出道峰值压差、二尖瓣收缩期前向运动征和二尖瓣反流分级变化,同时抽血检测术前、术后血浆N末端B型利钠肽原水平变化,采用纽约心脏协会心功能分级评估心功能。结果:本组患者中,接受单纯改良扩大Morrow手术者17例(58.6%),同时行冠状动脉旁路移植术者8例(27.6%)。与术前比较,改良扩大Morrow手术后患者的室间隔厚度显著减小[(24.6±6.8)mm vs(16.9±7.1)mm,P<0.01],左心室流出道峰值压差明显降低[(68.8±15.7)mm Hg(1 mm Hg=0.133 k Pa)vs(10.7±4.2)mm Hg,P<0.01],二尖瓣反流明显减轻[(1.7±1.3)级vs(0.2±0.4)级,P<0.01],纽约心脏协会心功能分级显著改善[(3.4±0.8)级vs(1.4±0.5)级,P<0.01],血浆N末端B型利钠肽原水平显著下降[(1957.6±392.5)ng/ml vs(458.7±161.0)ng/ml,P<0.01]。无围手术期死亡。术后第12、24、36个月患者的生存率分别为100.0%、86.7%和86.7%。结论:改良扩大Morrow手术是治疗青少年HOCM安全、有效的手段,术中充分暴露是保证手术效果的重要措施。Objective： To evaluate the efficacy of modified extended Morrow procedure on hypertrophic obstructive cardiomyopathy （HOCM） in adolescent patients. Methods： We retrospectively studied 29 consecutive HOCM patients at the age≤21 years who received modified extended Morrow procedure in our hospital from 2011 to 2015 for their clinical conditions to assess surgical efficacy. Echocardiography was performed to compare left atrial size, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular outflow tract peak pressure, ventricular septal thickness, mitral systolic anterior motion and mitral regurgitation grade before and after operation. Moreover, pre-operative and post-operative plasma NT-proBNP levels were determined. Cardiac function was evaluated by New York Heart Association functional class. Results： There were 17 （58.6%） patients received isolated modified extended Morrow procedure and 12 patients had concomitant operation including 8 （27.6%） with coronary artery bypass grafting. Compared with pre-operation, the post- operative thickness of ventricular septum decreased from （24.6± 6.8） mm to （16.9 ± 7.1） mm, left ventricular outflow tract gradient decreased from （68.8± 15.7） mmHg to （10.7 ± 4.2） mmHg, both P〈0.001; mitral regurgitation degree reduced from （1.7 ± 1.3） to （0.2 ± 0.4）, P〈0.01; NYHA classification improved from （3.4 ±0.8） to （1.4 ±0.5）, P〈0.01; plasma level ofNT-proBNP reduced from （1957.6 ±392.5） ng/ml to （458.7±161.0） ng/ml, P〈0.01. There was no peri-operative death, the survival rates at 12, 24 and 36 months post-operation were 100%, 86.7% and 86.7% respectively. Conclusion： Modified extended Morrow procedure has been a safe and effective method for treating adolescent HOCM patients, adequate exposure is the key point to assure surgical efficacy.

关 键 词：心肌病 肥厚性 改良扩大Morrow术 治疗结果 

分 类 号：R54[医药卫生—心血管疾病]