摘要
目的：分析外科手术矫治肥厚型梗阻性心肌病（HOCM）患者围术期心律失常特点及治疗策略。方法：1996—10至2009—12，76例患者因HOCM经常规主动脉切口行室间隔心肌切除术。术前主要心律失常类型：偶发室性早搏（6例）、完全右束支传导阻滞（5例）、阵发性房性心动过速（4例）、心房颤动（3例）、短阵室性心动过速（3例）。结果：全组手术死亡4例（5．3％，4／76），主要死困：顽固性心律失常、严重低心排血量综合征及急性肾功能衰竭。与术前比较，生存患者术后左心房内径及左心室内径均减小、左心室流出道压差下降、室间隔厚度变薄，差异均有统计学意义（P〈0．01～0．05）。术后主要心电图异常表现：完全左束支传导阻滞（40例）、室内传导阻滞（8例）、Ⅲ度房室传导阻滞（7例）、心房颤动（7例）、偶发室性早搏（7例）、左前分支传导阻滞（6例）、Ⅰ度房室传导阻滞（5例）。结论：HOCM患者术后心电图主要异常表现为传导束传导异常和心房颤动：如术前合并完全右束支传导阻滞，术后极易合并Ⅲ度房室传导阻滞，需引起重视。
Objective：To analyze the arrhythmia and its treating strategy in patients with hypertrophic obstructive cardiomyopathy （ HOCM ） during peri-operative period. Methods ：We summarize 76 HOCM patients who were surgically treated in our hospital from 1996 to 2009. The patients were 6 - 68 （37. 18 ± 15.85 ） years of age, the major pre-operative ECG abnormal variants were as premature ventricular contraction ： 6 cases,the right bundle branch block ： 5 cases, nonsustained atrial tachycardia ： 4 cases, atrial fibrillation ： 3 cases, and paroxysmal ventricular tachycardia：3 cases. The ventricular septal myotomy-myectomy was performed, and during the peri-operative period, the patients were examined by echocardiography,ECG or Doppler echocardiogram. Results：Four patients （4/76,5. 3% ）died during peri-operative period with severe ventricular arrhythmia, low cardiac output and acute renal failure. The diameter of left atrium and left ventricle, the pressure gradients through left ventricular outflow tract （LVOT） and the septal thickness were obvious decreased after the operation,P 〈 0. 01 -0. 05 respectively. The major post-operative ECG abnormal variants were as left bundle branch block ： 40 cases, intraventricular conduction block ： 8 cases, Ⅲ° artioventrical （AV） block ： 7 cases,atrial fibrillation：7 cases ,premature ventricular contraction：7 cases ,left anterior hemiblock ：6 cases,Ⅰ°AV block：5 cases. Conclusion：The major post-operative ECG abnormal changes for HOCM patients are bundle branch block and atrial fibrillation. If the patients combined with right bundle branch block before the operation, then they usually have more chance to suffer from Ⅲ° Av block after the operation, which should be emphasized in clinical practice.
出处
《中国循环杂志》
CSCD
北大核心
2011年第2期129-132,共4页
Chinese Circulation Journal
关键词
肥厚型梗阻性心肌病
室间隔肥厚心肌切除术
心律失常
治疗
Hypertrophic obstructive cardiomyopathy
Ventricular septal myotomy-myectomy
Arrhythmia
Therapy
