摘要
目的探讨室间隔心肌切除术治疗肥厚型梗阻性心肌病的临床疗效及安全性。方法以2014年1月至2018年1月该院收治的64例肥厚型梗阻性心肌病患者为研究对象,住院期间均实施室间隔心肌切除术,手术于全身麻醉低温体外循环下完成。回顾性分析患者一般资料、手术情况及随访情况。结果术后死亡2例(3.1%),1例死于感染性休克合并急性肾衰竭,另1例死于顽固性心律失常合并低心排血量综合征。与术前相比,术后存活的62例患者左心房内径、左心室舒张期末内径、左心室流出道压差、室间隔厚度及射血分数均降低,差异有统计学意义(P<0.05),同时二尖瓣反流及二尖瓣前向运动(SAM)征均有显著改善。术后发生率最高的心律失常类型为完全性左束支传导阻滞[32例(51.6%)]。存活的62例患者均痊愈出院,平均随访时间(24.3±6.7)个月,随访期间无死亡病例,未出现严重并发症需要再次手术者。术前、术后3、6、12个月患者明尼苏达心力衰竭生活质量量表(MLHFFQ)评分比较,差异有统计学意义(P<0.05),且随着随访时间延长MLHFFQ评分下降。结论室间隔心肌切除术治疗肥厚型梗阻性心肌病疗效确切,可显著改善左心室流出道梗阻的症状,远期安全性较高,值得临床推广。
Objective To explore the clinical efficacy and safety of ventricular septal Myocardiectomy in the treatment of hypertrophic obstructive cardiomyopathy.Methods From January 2014 to January 2018,64 patients with hypertrophic obstructive cardiomyopathy admitted in this hospital were selected as subjects.All patients underwent ventricular septal myocardial resection during hospitalization,and the operation was performed under general anesthesia and hypothermic cardiopulmonary bypass.A retrospective analysis of the general data,surgical conditions and follow-up was performed.Results Two patients(3.1%)died postoperatively,one case died of septic shock with acute renal failure,and the other one died of refractory arrhythmia with low cardiac output syndrome.Compared with preoperation,the left atrial diameter,left ventricular enddiastolic diameter,left ventricular outflow tract pressure difference,interventricular septum thickness and ejection fraction of 62 patients survived after operation were all decreased(P<0.05),while mitral regurgitation and mitral forward motion(SAM)were significantly improved.The highest incidence of arrhythmia after operation was complete left bundle branch block[32 cases(51.6%)].All 62 surviving patients recovered and discharged from hospital.The average follow-up time was(24.3±6.7)months.During the follow-up period,there were no deaths and no serious complications requiring reoperation.There was significant difference in MLHFFQ quality of life score before,3,6,and 12 months after surgery(P<0.05).With the prolongation of follow-up time,the score decreased.Conclusion Conclusions Interventricular septal myocardiectomy is effective in the treatment of hypertrophic obstructive cardiomyopathy.It can significantly improve the symptoms of left ventricular outflow tract obstruction,and has high long-term safety,which is worthy of clinical promotion.
作者
周洋
赵飞
唐仕海
郑波
彭华利
ZHOU Yang;ZHAO Fei;TANG Shihai;ZHENG Bo;PENG Huali(Department of Thoracic Surgery,the People's Hospital of Leshan,Leshan,Sichuan 614000,China)
出处
《重庆医学》
CAS
2019年第24期4169-4172,共4页
Chongqing medicine
基金
四川省医学科研青年创新课题(Q17041)
关键词
肥厚型梗阻性心肌病
室间隔心肌切除术
二尖瓣闭锁不全
二尖瓣前向运动征
hypertrophic obstructive cardiomyopathy
ventricular septal myotomy-myectomy
mitral valve insufficiency
mitral forward motion sign
作者简介
周洋(1980-),副主任医师,博士,主要从事心脏大血管外科研究。
