不同术式治疗肥厚型梗阻性心肌病效果的研究  

Comparison of surgical results in patients with hypertrophic obstructive cardiomyopathy after different operations

作　　者：郭鸿昌 王生伟 马赫赫 任长伟[1] 韩博[1] 于建波[1] 来永强[1] GUO Hongchang;WANG Shengwei;MA Hehe;REN Changwei;HAN Bo;YU Jianbo;LAI Yongqiang(Cardiac Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科中心,100029

出　　处：《心肺血管病杂志》2020年第6期703-705,710,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:本研究是比较肥厚型梗阻性心肌病(HOCM)患者接受经典Morrow术和改良Morrow术的手术效果。方法:从2008年12月到2016年12月,我院对有症状的HOCM患者共236例进行了手术治疗。其中86例接受经典术,150例接受改良术。记录患者围手术期的血流动力学资料及随访资料。结果:两种术式术前和术后左心室室间隔厚度[经典M术(22.1±11.9)vs.(17.1±4.0)mm;改良术(22.3±4.4)vs.(16.1±3.5)mm,P<0.01],左心室流出道压差经典术[73.9(55.8,100.0)vs.10.2(7.0,14.4)mmHg,1 mmHg=0.133 kPa],改良术[73.9(55.8,100.0)vs.10.2(7.0,14.4)mmHg,P<0.01]。患者接受两种手术方式后室间厚度、左心室流出道压差明显降低,但改良组患者术后左心室流出道流速和压差比经典组下降更明显。结论:经典术和改良术均能降低HOCM患者左心室流出道梗阻,但改良术对于左心室流出道梗阻的缓解更好。Objective:The study was conducted to evaluate the surgical result in patients with hypertrophic obstructive cardiomyopathy(HOCM)who underwent different myectomy procedure.Methods:236 symptomatic HOCM patients underwent surgical treatment from December 2008 to December 2016.Among them,86 patients were treated by the classic Morrow myectomy and 150 patients received the modified procedure.Septal thickness,maximal left ventricular pressure gradient(PG),and the presence of a permanent pacemaker were recorded after operation and follow-up.Results:The left ventricular septal thickness(22.1±11.9)vs.(17.1±4.0)mm for classic procedure,and(22.3±4.4)vs.(16.1±3.5)mm for modified procedure;(P<0.01),LVOT PG[73.9(55.8,100.0)vs.10.2(7.0,14.4)mmHg]for classic procedure,and[73.9(55.8,100.0)vs.10.2(7.0,14.4)mmHg]for modified procedure(P<0.01)were significantly decreased after the operation in both groups.The modified group,however,showed significantly greater reduction in these echocardiographic parameters than the classic group.Both of the procedures can reduce LVOT obstruction and alleviate symptoms in HOCM patients.Conclusions:The modified Morrow septal myectomy is superior to the classic procedure in reducing the LVOT gradient with a lower incidence of mitral valve replacement.

关 键 词：肥厚型梗阻性心肌病 心肌部分切除术 

分 类 号：R54[医药卫生—心血管疾病]