老年梗阻性肥厚型心肌病患者经皮室间隔化学消融术有效性和安全性分析  

Efficacy and safety of percutaneous transluminal septal myocardial ablation in elderly patients with obstructive hypertrophic cardiomyopathy

作　　者：郑顺文 戴锦杰[1] 施鸿毓[1] 秦牧 陈晖[1] 吴卫华[1] 刘旭[1] 何奔 仇兴标[1] ZHENG Shun-wen;DAI Jin-jie;SHI Hong-yu;QIN Mu;CHEN Hui;WU Wei-hua;LIU Xu;HE Ben;QIU Xing-biao(Department of Cardiology,Shanghai Chest Hospital,Shanghai Jiaotong University,Shanghai 200030,China)

机构地区：[1]上海交通大学附属胸科医院心内科

出　　处：《中国介入心脏病学杂志》2020年第1期10-15,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金面上项目(81770324)

摘　　要：目的评估经皮室间隔化学消融术(PTSMA)在老年药物难治性梗阻性肥厚型心肌病患者中的有效性和安全性。方法连续收录上海交通大学附属胸科医院2001年4月至2019年1月行PTSMA治疗的梗阻性肥厚型心肌病患者,按照年龄分成青年组(年龄<55岁)和老年组(年龄≥55岁)。通过查阅病历记录患者的一般资料、临床病史、手术情况及住院期间并发症发生情况,以及通过电话或门诊随访所记录患者的生命状态、临床表现和心功能情况,应用Kaplan-Meier法分析两组生存曲线。结果共111例患者纳入本研究,中位年龄为56.0(15.0,82.0)岁,女性共42例(37.8%),其中青年组中位年龄43.5(15.0,54.0)岁,老年组中位年龄为63.0(55.0,82.0)岁。总体消融成功率为68.5%,青年组、老年组分别为66.7%、70.0%。术中无水酒精中位注射量为2.0(1.0,5.0)ml,青年组和老年组分别为2.1(1.0,5.0)ml和2.0(1.0,5.0)ml,两组比较差异无统计学意义(P=0.728)。房室传导阻滞、室性心律失常、低血压为手术常见并发症,2例患者(均≥55岁)因持续高度房室传导阻滞需植入永久起搏器,1例患者(66岁)因术后心室颤动、心原性休克经抢救无效死亡。老年组患者围术期主要不良心血管事件(包括心原性死亡,高度房室传导阻滞需植入永久起搏器,由于心室颤动或室性心动过速引起的心搏骤停复苏等)发生率较青年组高(P=0.060)。111例患者除外1例围术期死亡,对其余110例患者进行了长期随访,随访时间为3~212(35.5±48.5)个月,随访率为86.4%(95/110),全因死亡11例,总死亡率为10.0%(11/110),除外1例因肺部感染死亡,其余10例为肥厚型心肌病相关死亡,包括6例心原性猝死,3例因心房颤动、急性脑梗死致死,1例心力衰竭致死。梗阻性肥厚型心肌病患者PTSMA后1年、5年和10年的总生存率分别为96.9%、93.4%和81.1%。青年组和老年组1年、5年、10年总生存率分别97.7%、97.7%、91.6%和96.2%、89.Objective To evaluate the efficacy and safety of percutaneous transluminal septal myocardial ablation(PTSMA)in elderly symptomatic patients with drug-refractory obstructive hypertrophic cardiomyopathy.Methods A total of 111 consecutive patients with obstructive hypertrophic cardiomyopathy who underwent PTSMA in Shanghai Chest Hospital,Shanghai Jiao Tong University from April 2001 to January 2019 were divided into young(age<55 years)and elderly(age≥55 years)groups.The general information,medical history,procedure and in-hospital major adverse cardiovascular events were obtained by review of the records,and follow-up data including survival status,clinical presentation and cardiac function were gathered by outpatient or telephone.Kaplan-Meier were used to analyze the survival curve of the two groups.Results 111 patients were included in the study,the median age was 56.0(15.0,82.0),and there were 42 females(37.8%),the median age was 43.5(15.0,54.0)in the youth group and 63.0(55.0,82.0)in the elderly group,respectively.The overall success rate of PTSMA was 68.5%,the success rate of the youth group and the elderly group were 66.7%and 70.0%,respectively.The median injection amount of anhydrous alcohol was 2.0(1.0,5.0)ml,2.1(1.0,5.0)ml in the young group and 2.0(1.0,5.0)ml in the elderly group(P=0.728).Atrioventricular block,ventricular arrhythmia,hypotension were common complications of operation,and 2 cases(age≥55 years old)need to be implanted with permanent pacemaker due to continuous high atrioventricular block,1 patients(66 years old)died due to ventricular fi brillation and cardiac shock.The incidence of major perioperative cardiovascular events(including cardiac death,permanent pacemaker implantation due to high atrioventricular block,resuscitation of cardiac arrest due to ventricular fi brillation or ventricular velocity)in elderly patients was higher than that in young patients(P=0.060).The remaining 110 patients were followed up for(35.5±48.5)months(range 3–212 months)except 1 case died during perioper

关 键 词：梗阻性肥厚型心肌病 经皮室间隔化学消融术 有效性 安全性 老年 

分 类 号：R541.4[医药卫生—心血管疾病]