摘要
目的评价外科手术治疗肥厚梗阻性心肌病的临床疗效。方法1996年10月—2007年12月，54例患者因肥厚梗阻性心肌病行外科手术治疗，男37例、女17例，年龄6～68（36±16）岁，体重27～83（60±14）k。手术在全麻低温体外循环下完成，按常规经主动脉切口行室间隔心肌切除术（改良Morrow技术），其中3例患者因左室流出道狭窄解除不满意，二次转机行左室流出道疏通。同期行冠状动脉旁路移植术5例，二尖瓣置换术9例，二尖瓣成形术5例，主动脉瓣置换4例，三尖瓣成形术2例，动脉导管切缝术2例，主动脉瓣下隔膜切除术1例。围术期心脏超声心动图（UCG）或食道超声心动图（TEE）评价左心房（LA）、左心室（LV）、左室流出道流速及压差（LVOT）、左室射血分数（EF）、二尖瓣结构和功能。结果全组体外循环时间40～290（107±52）min、主动脉阻断时间20～195（70±36）min、气管插管时间5～21（14±15）h、ICU住院时间11—183（45±34）h。与术前相比，术后LA大小（术前42±8、术后35±7）、左室流出道压差[术前（106±44）mmHg、术后（24±19）mmHg]、室间隔厚度[术前（27±6）mm、术后（19±5）mm]、左室射血分数（术前70±10、术后61±9）均显著下降（P〈0．05）。二尖瓣关闭好或仅轻度返流，SAM征消失。手术死亡4例（7．4％，4／54），主要死因：严重低心排综合征、严重心律失常及急性肾功能衰竭。主要并发症：完全性房室传导阻滞4例（其中3例安装永久起搏器）、完全左束支或左前分支阻滞26例，室内传导阻滞1，Ⅰ度房室传导阻滞4例。远期随访：所有生存患者症状消失，生命质量明显改善，心功能Ⅰ～Ⅱ级，无远期死亡或并发症。结论肥厚梗阻性心肌病外科手术可满意的减轻左室流出道梗阻，提高患者的生命质量。
Objective To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy （HOCM）. Methods From October 1996 to December 2007, 54 HOCM patients underwent surgical treatment. There were 37 males and 17 females ranging from 6 to 68 years old （36 ± 16） with body weight 27-83 （60 ± 14） kg. Operation was performed under general anesthesia and cardiopulmonary bypass （CPB） with the moderate systemic temperature and low volume blood flow. The concomitant operations included coronary artery bypass grafting in 5 cases, mitral valve plasty in 5 cases, mitral valve replacement in 9 cases, tricuspid valve plasty in 2 cases, aortic valve replacement in 4 cases and closure of patent ductus arteriosus in 2 cases. Preoperative and postoperative left ventricular （ LV ）, left ventricular outflow tract （LVOT）, left atrium （LA）, mitral valve function and value of LVEF were evaluated by transesophageal echocardiograph examination. Results The time of CPB and aortic occlusion were 40 to 290 minutes （ 107 ± 52） and 27 to 195 min （70 ± 36 min） respectively. The endotracheal intubation durations were 5 to 21 hours （ 14 ± 15 ） and ICU duration 11 to 183 hours （45 ± 34）. Comparing with the pre-operative echocardiographic parameters, the size of left atrium （42 ± 8 vs 35 ± 7 ） , pressure gradients through LVOT （106 ± 44 mm Hg vs 24 ± 19 mm Hg）, the thickness of septum （27 ±6 mm vs 19 ±5 mm） and the value of EF （70 ± 10 vs 61 ±9） obviously decreased postoperatively （P 〈 0. 05 ）. The surviving patients had either no mitral valve regurgitation or only mild mitral valve regurgitation. Four （ 7.4% ） patients died during the perioperative period. The cause of death included severe low cardiac output, heart failure, severe ventricular arrhythmias and severe acute renal failure. There were 4 patients with a complete AV block postoperatively and 3 wereimplanted permanent pacemakers. The left bandle branch block or left anterior hemiblock were found in 26 ca
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第39期2776-2778,共3页
National Medical Journal of China
关键词
心肌病
肥大性
二尖瓣
外科手术
Cardiomyopathy, hypertrophic
Mitral valve
Surgical procedures, operative
