肥厚型梗阻性心肌病的外科治疗  

Clinical experience of surgical treatment on hypertrophic obstructive cardiomyopathy

作　　者：马红艳[1] 张勤斌[1] 周宏[1] 

机构地区：[1]武汉亚洲心脏病医院心脏中心,湖北省武汉市430000

出　　处：《中国心血管病研究》2017年第4期354-358,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 评价外科手术治疗肥厚梗阻性心肌病的临床疗效.方法 2010年1月至2013年10月,72例患者因肥厚梗阻性心肌病在我院行外科手术治疗,男性36例,女性36例,年龄13～70（46.51±13.45）岁.手术在全麻低温体外循环下完成,按常规经主动脉切口行室间隔心肌切除术,同期行冠状动脉旁路移植术4例、二尖瓣置换术8例、二尖瓣成形术2例、主动脉瓣置换术2例、主动脉瓣成形术1例、动脉导管结扎术1例、右室流出道疏通术1例、左房血栓清除1例、左心耳结扎2例、冲洗式射频消融改良迷宫术4例、安装永久起搏器2例.围术期心脏超声心动图（UCG）或食管超声心动图（TEE）评价左心室舒张末径、左室流出道流速及压差（LVOT）、室间隔厚度、左室射血分数（EF）、二尖瓣结构和功能.结果 与术前比较,左室流出道压差[（9.42±7.48）mm Hg比（79.76±51.9）mm Hg,P＜0.01]及室间隔厚度[（1.87±0.57）cm比（2.36±0.48）cm,P＜0.01]明显下降,长期随访发现左室流出道压差进一步下降[（7.57±5.21）mm Hg],室间隔厚度进一步变薄[（1.69±0.45）cm].左室舒张末径在出院时有所扩大,长期随访有进一步扩大趋势.EF值较术前有所下降（P＜0.01）,但仍在正常范围内.手术死亡0例.主要并发症：完全性左束支传导阻滞52例,右束支传导阻滞2例,室内传导阻滞3例,心房颤动7例（其中3例为阵发性房颤）,短暂Ⅱ～Ⅲ度房室传导阻滞5例,持续Ⅲ度房室传导阻滞2例,室间隔穿孔1例,术后脑出血2例,急性胆囊炎1例.远期随访：5例失访,余67例术后随访3～53个月（平均18个月）,所有患者症状消失,生活质量明显改善,心功能Ⅰ～Ⅱ级,无远期死亡或并发症.结论 肥厚梗阻性心肌病外科手术治疗可有效地减轻左室流出道梗阻,提高患者的生活质量.Objective To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy （HOCM）.Methods From January 2010 to October 2013,72 HOCM patients underwent surgical treatment in our hospital.There were 36 males and 36 females ranging from 13-70 （46.51-±13.45）years old.Operation was performed under general anesthesia and cardiopulmonary bypass（CPB） with the moderate systemic temperature and low volume blood flow.The concomitant operations included coronary artery bypass grafting in 4 cases,mitral valve replacement in 8 cases,mitral valve plasty in 2 cases,aortic valve replacement in 2 cases,aortic valve plasty in 1 case,closure of patent ductus arteriosus in 1 case,right ventricular outflow dredging operation in 1 case,left atrial thrombus removal in 1 case,left atrial appendage ligation in 2 cases,maze procedure in 4 cases,intraoperative pacemaker implantation in 2 cases.Preoperative and postoperative left ventricular end diastolic diameter,left ventricular outflow tract（LVOT）,interventricular septal thickness,LVEF,mitral valve function and value were evaluated by Ultrasonic echocardiography and transesophageal echocardiograph examination （TEE）.Results Comparing with the pre-operative echocardiographic parameters,the pressure of left ventricular outflow tract [（9.42±7.48）mm Hg vs （79.76±51.9）mm Hg,P〈0.01],and the thickness of septum [（1.87-±0.57）cm vs （2.36-±0.48）cm,P〈0.01] significantly decreased.Long-term follow-up of left ventricular outflow tract pressure decreased further（7.57±5.21） mm Hg,the thickness of septum thinner further （1.69-±0.45）cm.Left ventricular end diastolic diameter at the time of discharge has been expanded,and has further expanded at long-term follow-up.EF decreased （P〈0.01）,but still in the normal range.There was no one dead.The main complications：complete left bundle branch block in 52 cases,right bundle branch block in 2 cases,intraventricular block in 3 cases,atrial fibrillation in 7 cases（including 3 cases of paroxy

关 键 词：心肌病 肥厚性 二尖瓣关闭不全 外科手术 SAM征 

分 类 号：R654.2[医药卫生—外科学]