心脏超声技术在外科治疗肥厚型梗阻性心肌病中的应用价值  

The Value of Echocardiography in the Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy

作　　者：刘英梅[1] 韦育林[1] 张智 王培伟 

机构地区：[1]中山大学孙逸仙纪念医院心内科,广东省心电生理和心律失常重点实验室,510120 [2]广州市老人院超声科,510550

出　　处：《岭南急诊医学杂志》2017年第6期558-560,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:探讨心脏超声技术在肥厚型梗阻性心肌病(HOCM)患者外科治疗过程中的应用价值。方法:回顾性分析2007年1月-2017年1月经确诊并行手术治疗的36例HOCM患者的临床资料,比较治疗前后2周及6个月心脏超声测量参数。结果:心脏超声参数显示:术后2周,室间隔厚度明显变薄[(23.48±2.32 mm)vs(16.24±2.06)mm,P<0.01];左室流出道内径扩大[(8.42±4.37 mm)vs(13.46±2.35)mm,P<0.01];左室舒张末径较术前增加[(40.56±3.32 mm)vs(44.89±4.81)mm,P<0.01];左室流出道压差显著下降[(98.23±32.35)mm Hg vs(32.45±21.67)mm Hg,P<0.01];术后6个月随访,左房内径较术前减小[(38.26±4.37mm)vs(42.03±5.36)mm,P<0.01],其余指标稳定在术后2周水平。术前所有患者均存在不同程度的SAM征及二尖瓣返流;术后2周及6个月随访二尖瓣返流程度及SAM征明显改善或消失。结论:心脏超声在HOCM外科治疗的术前确诊、术后评估及长期随访过程中具有重要的临床应用价值。Objective：To evaluate the value of echocardiography in the surgical treatment of hypertrophic obstructive cardiomyopathy（HOCM）. Methods：The clinical data of 36 patients with HOCM underwent modified extended Morrow procedure from Jan 2007 to Jan 2017. The echo measure results of pre-operation were compared with operation after2 weeks and 6 months. Results：All 36 patients had the characteristic of marked left ventricular asymmetric hypertrophy.Echo index revealed that after 2 weeks operation,the thickness of the ventricular septum was decreased[（23.48 ±2.32 mm）vs（16.24±2.06）mm,P0.01]. The diameter of LVOT and LV diastolic diameter were all enlarged[（8.42±4.37 mm）vs（13.46±2.35）mm,P0.01]and[（40.56±3.32 mm）vs（44.89±4.81）mm,P0.01]. The peak gradient between the LV and the aorta was markedly decreased[（98.23±32.35）mm Hg vs（32.45±21.67）mm Hg,P0.01]. After 6 months follow up,the LA size was decreased compared with pre-operation[（38.26±4.37 mm）vs（42.03±5.36）mm,P0.01]. Before Morrow operation,all patients had different degree of SAM phenomenon and mitral valve regurgitation（MR）. After 6 months follow up of operation,MR and SAM phenomenon were improved or disappeared. Conclusion：Echocardiography plays an important role in the surgical management of HOCM. It is very valuable for the HOCM diagnosis of pre-operation and surgical effective evaluation of post-operation and follow-up.

关 键 词：肥厚型梗阻性心肌病 心脏超声 外科手术 

分 类 号：R654.2[医药卫生—外科学]