摘要
目的回顾性分析肥厚梗阻性心肌病患者行双腔起搏器植入（PM）或经皮室间隔化学消融（PTMSA）治疗，评价两种治疗方法的远期疗效。方法48例患者，19例行PM治疗，29例行PTMSA治疗，并随访超声心动图结果。电话随访患者的临床症状。结果PM组，平均年龄（51±13）岁，平均随访时间（3．9±2．3）年，起搏模式为DDD，AV延迟间期90～110ms，治疗前后左心室流出道压力阶差分别是（103．8±40．6）mmHg（11mm Hg=0．133kPa）和（45．1±36．2）mm Hg，P〈0．05。PTMSA组，平均年龄（43±11）岁，随访时间（3．6±1．2）年，治疗前后左心室流出道压力阶差分别是（85．74-21．1）mmHg和（24．6±12．2）mm Hg，P〈0．05。PTMSA组左心室流出道压力阶差下降幅度大于PM治疗组[（71±12）％vs（58±29）％，P〈0．05）。PTMSA术后并发症为心律失常，发生率38％，主要为各种心律失常；PM术后主要为起搏器相关并发症发生率5．3％，主要为起搏器相关并发症。PTMSA组14例有晕厥史的患者中有1例术后活动时仍偶发晕厥，胸痛、胸闷症状缓解率75％。PM组10例有晕厥史的患者术后未再发，胸痛、胸闷症状缓解率93．8％。结论双腔起搏器及经皮室间隔化学消融治疗肥厚梗阻性心肌病均可降低患者的左心室流出道压力阶差，起搏治疗降低左心室流出道压力阶差的幅度低于消融治疗。消融治疗的并发症高于起搏治疗。两种治疗方法均可改善患者临床症状。
Objective A retrospective study of the long-term effects of dual-chamber pacing on regional myocardial and percutaneous transluminal scptal ablation in patients with hypertrophic obstructive cardiomyopathy was conducted in Fuwai hospital. Methods The left ventricular outflow tract gradient （LVOTG） and clinical symptoms before and after pacemaker （PM） and percutaneous transluminal septal ablation （PTMSA） therapy were compared and patients were followed-up by telephone. Results Ninteen patients were treated with PM and 29 patients were treated with PTMSA. The LVOTG before and after PM is （ 103.8 ±40.6） mm Hg vs. （45.1 ± 36.2） mm Hg, P〈0.05; while the LVOTG before and after PTMSA is （85.7 ±21.1 ） mm Hg vs. （24.6 ± 12.2） mm Hg,P〈0.05. The LVOTG was down （71 ± 12） % in PTMSA patients and is much significantly than that in PM patients （58 ± 29） %, P 〈 0. 05. There were higher complications in PTMSA patients than in PM patients. While clinical symptoms were improved more significantly in patients treated with PM and PTMSA. Conclusions Both therapeutic PM and PTMSA improved clinical symptoms and decreased LVOTG.
出处
《中华心律失常学杂志》
2009年第6期412-415,共4页
Chinese Journal of Cardiac Arrhythmias
关键词
肥厚梗阻性心肌病
双腔起搏
经皮室间隔化学消融术
Hypertrophic obstructive cardiomyopathy
Dual-chamber pacing
Percutaneous transluminal septal ablation
