肥厚型梗阻性心肌病患者室间隔肥厚及二尖瓣射频消融术相关指标的影响  

The impact of ventricular septal hypertrophy and mitral valve related parameters of ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy

作　　者：张华[1] 张宇[1] 宣学习 王明杰 夏开 尹浡 谭远远 张传西 厉菁[1] ZHANG Hua;ZHANG Yu;XUAN Xuexi;WANG Mingjie;XIA Kai;YIN Bo;TAN Yuanyuan;ZHANG Chuanxi;LI Jing(The 7th People’s Hospital of Zhengzhou Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院,450000

出　　处：《心肺血管病杂志》2023年第10期1001-1006,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技公关计划项目(LHGJ20210750)。

摘　　要：目的:分析超声引导下经皮心肌内室间隔射频消融术(percutaneous intramyocardial septal radiofrequency ablation,PIMSRA)对肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)患者室间隔肥厚及二尖瓣相关指标的影响。方法:回顾性分析2020年1月至2021年12月,接受PIMSRA治疗的HOCM患者38例临床资料,观察PIMSRA消融情况、术前与随访6个月室间隔肥厚及二尖瓣相关指标、堪萨斯城心肌病患者生命质量量表(KCCQ)、并发症。结果:①HOCM患者LVEDD、左心室流出道内径(lefct ventricular outflow tract,LVOT)大于手术前(P<0.05),前间隔厚度、后间隔厚度、左心室流出道峰值压力阶差(LVOT-PG)小于手术前(P<0.05)。②二尖瓣反流长度、反流面积、反流体积低于手术前(P<0.05),二尖瓣环收缩早期峰值速度高于手术前(P<0.05);无收缩期二尖瓣前叶前向运动42.1%高于术前10.5%(χ^(2)=9.771,P<0.05)。③HOCM患者生活质量各维度及总分均高于术前(P<0.05)。④美国纽约心脏病学会(NYHA)心功能分级Ⅰ级率63.2%高于术前13.2%(P<0.05);胸闷、胸痛、心悸、眩晕发生率低于术前(P<0.05)。⑤术中发生一过性左束支传导阻滞1例、右束支传导阻滞2例。结论:超声引导下PIMSRA术能够缓解室间隔肥厚及二尖瓣反流症状,改善HOCM患者心脏功能,且不增加心律失常发病风险。Objective:To study effect of ventricular septal hypertrophy and mitral valve related parameters of ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:38 HOCM patients with PIMSRA therapy from January 2020 to December 2020 were retrospectively.then PIMSRA ablation,ventricular septal hypertrophy,mitral valve related indexes,and complications were observed.Preoperative and follow-up for 6 months,Used KCCQ assessment of HCOM patients'quality of life(physical limitations,self-evaluation,clinical symptoms,social functioning,self-knowledge,psychological status).Results:①HOCM patient LVEDD,lefct ventricular outflow tract(LVOT)higher than before surgery(P<0.05).Anterior interval thickness,posterior interval thickness,left ventricular outflow trct peak grakient(LVOT-PG)lower than before surgery(P<0.05).②Mitral regurgitation length,regurgitation area,regurgitation volume lower than that before surgery(P<0.05).Peak early systolic velocity of Mitral annulus higher than before surgery(P<0.05).No contraction mitral valve systolic anterior motion,(SAM)42.1%higher than before surgery 10.5%(P<0.05).③HOCM patients life quality dimensions and total score higher than that before surgery(P<0.05).④NYHAⅠrate 63.2%higher than before surgery 13.2%(P<0.05).Chest tightness,chest pain,palpitations,vertigo rate lower than before surgery(P<0.05).⑤1 case transient left bundle branch block,2 cases right bundle branch block.Conclusions:Ultrasound-guided PIMSRA can relieve the symptoms of ventricular Septal hypertrophy and Mitral regurgitation,and improve the cardiac function of patients with Hocm,then does not increase the risk of Arrhythmia.

关 键 词：肥厚型梗阻性心肌病 经皮心肌内室间隔射频消融术 室间隔肥厚 二尖瓣前叶收缩期前向运动 

分 类 号：R54[医药卫生—心血管疾病]