明胶海绵化学消融治疗5例肥厚型梗阻性心肌病的有效性与安全性分析  

Efficacy and Safety of Gelatin Sponge as Embolic Medium for Chemical Ablation: Experience from 5 Patients With Hypertrophic Obstructive Cardiomyopathy

作　　者：唐炯 张黎 齐峰 杨娟 王曼[2] 张紫微 钱粉花 骆志玲 秦国华 王红 杨伟宪[2] TANG Jiong;ZHANG Li;QI Feng;YANG Juan;WANG Man;ZHANG Ziwei;QIAN Fenhua;LUO Zhiling;QIN Guohua;WANG Hong;YANG Weixian(Department of Cardiology,Fuwai Yunnan Cardiovascular Hospital,Kunming(650102),Yunnan,China)

机构地区：[1]云南省阜外心血管病医院心内科,昆明市650102 [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医院冠心病中心

出　　处：《中国循环杂志》2019年第12期1181-1185,共5页Chinese Circulation Journal

摘　　要：目的:评价明胶海绵作为肥厚型梗阻性心肌病间隔支化学消融栓塞介质的有效性和安全性,为肥厚型梗阻性心肌病消融提供无水酒精以外的介质选择。方法:分析2018年1月至2018年10月我院5例肥厚型梗阻性心肌病患者,经冠状动脉间隔支注入明胶海绵颗粒栓塞剂,进行化学消融术,通过左心室导管和经胸超声心动图评价左心室流出道压力阶差,同时收集手术前,术中及术后相关临床资料和检验结果,进行分析对比。结果:5例患者中男性3例,女性2例,平均年龄(57.00±10.56)岁,经胸超声心动图测量最大室间隔平均厚度(19.8±4.0)mm,每例患者消融1支间隔支,可吸收明胶海绵平均用量为(0.84±0.25)ml,手术中左心室导管监测左心室流出道压力阶差,术后即刻较术前显著下降[(92.2±28.8)mm Hg vs (42.2±16.6)mmHg, 1 mmHg=0.133 kPa,P<0.02],无相关并发症。术后8周随访,超声心动图检测平均左心室流出道压差较术前显著下降[(58.8±5.5)mmHg vs (23.6±2.3)mmHg,P<0.01],NYHA心功能分级显著改善[(2.8±0.4)级vs (1.6±0.5)级,P<0.05],B型利钠肽水平[(867.2±953.5)pg/ml vs(497.5±479.7) pg/ml]和最大室间隔厚度[(19.8±4.0) mm vs (16.8±1.7)mm,P>0.05]均较术前有所下降,但差异均无统计学意义。结论:明胶海绵作为栓塞介质,化学消融治疗肥厚型梗阻性心肌病的术后即刻及术后8周随访结果提示安全、有效,有望作为无水酒精的替代介质进行化学消融治疗。Objectives: To evaluate the safety and efficacy of gelatin sponge as an embolic medium for ablation of septal branches in patients with hypertrophic obstructive cardiomyopathy, and evaluate its feasibility as an alternative medium to alcohol for hypertrophic obstructive cardiomyopathy ablation.Methods: Five patients with hypertrophic obstructive cardiomyopathy were treated by ablation with gelatin sponge particle embolic agent injected into the target coronary septal branch in our hospital from January to October in 2018. The left ventricular outflow tract pressure gradient difference was evaluated by left ventricular catheter and transthoracic echocardiography. The clinical data before, during and after operation were collected for analysis.Results: There were 3 male and 2 female patients in this cohort, average age was(57.00±10.56) years. The mean maximum ventricular septum thickness measured by transthoracic echocardiography was(19.8±4.0) mm. The average dose of absorbable gelatin sponge used in each patient was(0.84±0.25) ml. The left ventricular pressure gradient measured by catheter immediately after operation was significantly lower than that before operation([42.2 ±16.6] mmHg vs [92.2±28.8] mmHg, 1 mmHg=0.133 kPa,P<0.02). No complications were found. Follow-up results at 8 weeks post procedure showed that the mean left ventricular outflow tract pressure gradient difference measured by echocardiography was significantly lower than that before operation( [23.6 ±2.3] vs. [58.8±5.5] mmHg, P<0.01), the NYHA classification was significantly improved([1.6 ±0.5] vs [2.8 ±0.4], P<0.05). Both BNP([867.2±953.5] pg/ml vs[497.5±479.7] pg/ml) and the maximum ventricular septal thickness([16.80±1.7] mm vs [19.8 ±4.0] mm, P>0.05) tended to be lower as compared to baseline levels.Conclusions: Immediate and 8-week follow-up results show that Gelatin sponge as an embolic medium is safe and effective in the chemical ablation treatment of hypertrophic obstructive cardiomyopathy. Gelatin sponge might be a promisin

关 键 词：明胶海绵 化学消融 心肌病 肥厚型 梗阻性 

分 类 号：R459.9[医药卫生—治疗学]