间隔心肌消融术与单纯药物治疗梗阻性肥厚型心肌病的临床对照研究  

Comparison of Clinical Effects of Septal Myocardial Ablation or Medication for Obstructive Hypertrophic Cardiomyopathy

作　　者：蔡华 张领 李满生 李新峰 CAI Hua;ZHANG Ling;LI Mansheng;LI Xinfeng(Second People′s Hospital of Pingdingshan,Pingdingshan 467000,Henan,China)

机构地区：[1]平顶山市第二人民医院

出　　处：《中西医结合心脑血管病杂志》2019年第24期3894-3897,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：河南省卫生科技创新型人才工程专项经费资助项目[豫卫科(2010)40]

摘　　要：目的分析间隔心肌消融术与单纯药物治疗对梗阻性肥厚型心肌病的临床疗效、血清γ-谷氨酰转移酶(GGT)、肌钙蛋白I(cTnI)水平及血流动力学的影响。方法回顾性分析2010年7月-2014年9月我院收治的50例梗阻性肥厚型心肌病病人临床资料,25例采用间隔心肌消融术治疗的病人设为观察组,25例采用单纯药物治疗的病人设为对照组。对比两组临床疗效、心功能相关指标变化、血流动力学指标变化、血清GGT及cTnI水平、并发症发生情况、3年生存率、死亡原因等。结果观察组治疗总有效率为84.00%,显著高于对照组的52.00%(P<0.05);观察组治疗后舒张早期充盈速度(E峰)、左室射血分数(LVEF)及左心室流出道压力阶差(LVOTPG)低于对照组,舒张晚期充盈速度(A峰)高于对照组(P<0.05);两组治疗后,血清GGT较治疗前降低,且观察组低于对照组(P<0.05);观察组治疗后血清cTnI较治疗前明显升高(P<0.05),对照组治疗后血清cTnI与治疗前相比差异无统计学意义(P>0.05);观察组并发症发生率、3年生存率与对照组相比差异无统计学意义(P>0.05),观察组有1例为心源性死亡,对照组有2例为心源性死亡,1例非心源性死亡。结论与单纯药物治疗相比,间隔心肌消融术治疗梗阻性肥厚型心肌病效果确切,心功能与血流动力学指标也明显改善,同时可降低血清GGT水平,减少并发症,降低死亡率,在心源性相关生存方面更具优势,且不会增加猝死风险,但可导致cTnI升高。Objective To analyse the effects of septal myocardial ablation or medication on the clinical efficacy,serumγ-glutamyl transferase(GGT),troponin I(cTnI)levels and hemodynamics in patients with obstructive hypertrophic cardiomyopathy.Methods The clinical data of 50 patients with obstructive hypertrophic cardiomyopathy in our hospital from July 2010 to September 2014 were retrospectively analyzed.Twenty-five patients treated with septal myocardial ablation were selected as the observation group,and 25 patients treated with medication were selected as the control group.The clinical efficacy,changes in cardiac function-related indicators and hemodynamic indicators,serum GGT and cTnI levels,complications,3-year survival rate,and causes of death were compared between two groups.Results The total effective rate was 84.00%in the observation group,which was significantly higher than that in the control group(52.00%,P<0.05).The E peak,left ventricular ejection fraction(LVEF)and left ventricular outflow tract pressure gradient(LVOTPG)in the observation group were lower than those in the control group,and the A peak was higher than that in the control group(P<0.05).After treatment,the serum GGT in two groups was lower than that before the treatment,which was significantly lower in the observation group than that of the control group(P<0.05).The serum cTnI in the observation group was significantly higher than that before the treatment(P<0.05).There was no significant difference in the incidence of complications and 3-year survival rate between the observation group and the control group(P>0.05).There was one case of cardiogenic death in the observation group,there were 2 case of cardiac death and 1 cases of non-cardiac death in the control group.Conclusion Compared with medication,septal myocardial ablation is exactly effective in patients with obstructive hypertrophic cardiomyopathy,which can improves the cardiac function and hemodynamics,reduce serum GGT level,reduce complications and mortality rate.At the same time,it has

关 键 词：梗阻性肥厚型心肌病 间隔心肌消融术 Γ-谷氨酰转移酶 肌钙蛋白I 血流动力学 

分 类 号：R542.2[医药卫生—心血管疾病] R256.2[医药卫生—内科学]