肥厚型心肌病患者的围术期管理
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摘要
肥厚型心肌病(HCM)患者围术期循环系统的不稳定性给麻醉及手术实施带来诸多挑战。大部分HCM患者无明确临床表现,临床中很可能会遇到未被诊断的HCM患者,麻醉医师应充分掌握HCM的临床表现、病理生理机制以及触发或加重左心室流出道梗阻的危险因素。术中经食管超声心动图有助于明确诊断、识别二尖瓣瓣膜形态及结构的异常、区分术中低血压的原因,进而指导治疗。HCM患者围术期风险高、管理难度大,因此探讨肥厚型心肌病患者行心脏手术及非心脏手术的围术期管理要点具有重要临床意义。
The perioperative circulatory system instability of patients with hypertrophic cardiomyopathy( HCM) poses many challenges regarding the conduct of anesthesia and surgery. Most patients affected by this disease have no clear clinical symptoms,and anesthetists may be confronted with clinically unrecognized HCM and must have a complete understanding of the relevant pathophysiology,clinical presentation and mechanisms that may trigger or accentuate dynamic left ventricle outflow tract obstruction. Intraoperative transesophageal echocardiography examination confirms the diagnosis,identifies morphological and structural abnormalities of mitral valve,distinguishes the causes of intraoperative hypotension and guides the treatment. The perioperative risk of patients with HCM is high and difficulty to manage,therefore,exploring the perioperative management of patients with HCM presenting for cardiac surgery or non-cardiac surgery has great clinical significance.
The perioperative circulatory system instability of patients with hypertrophic cardiomyopathy( HCM) poses many challenges regarding the conduct of anesthesia and surgery. Most patients affected by this disease have no clear clinical symptoms,and anesthetists may be confronted with clinically unrecognized HCM and must have a complete understanding of the relevant pathophysiology,clinical presentation and mechanisms that may trigger or accentuate dynamic left ventricle outflow tract obstruction. Intraoperative transesophageal echocardiography examination confirms the diagnosis,identifies morphological and structural abnormalities of mitral valve,distinguishes the causes of intraoperative hypotension and guides the treatment. The perioperative risk of patients with HCM is high and difficulty to manage,therefore,exploring the perioperative management of patients with HCM presenting for cardiac surgery or non-cardiac surgery has great clinical significance.
引文
[1] Maekawa Y, Akita K,Takanashi S. Contemporary septal reduction therapy in drug-refractory hypertrophic obstructive cardiomyopathy[J].Circ J,2018,82(8):1977-1984.
[2] Vives M,Roscoe A. Hypertrophic cardiomyopathy:Implications for anesthesia[J]. Minerva anestesiol,2014,80(12):1310-1319.
[3] Seeger T,Shrestha R, Lam CK, et al. A premature termination codon mutation in MYBPC3 causes hypertrophic cardiomyopathy via chronic activation of nonsense-mediated decay[J]. Circulation,2019,139(6):799-811.
[4] Marian AJ,Braunwald E. Hypertrophic cardiomyopathy:Genetics,pathogenesis,clinical manifestations,diagnosis,and therapy[J].Circ Res,2017,121(7):749-770.
[5] Gajewski M,Hillel Z. Anesthesia management of patients with hypertrophic obstructive cardiomyopathy[J]. Prog Cardiovasc Dis,2012,54(6):503-511.
[6] Bradic Z,Ivanovic,B,Markovic D,et al. Preoperative preparation of patients with cardiomyopathies in non-cardiac surgery[J]. Acta Chir Iugosl,2011,58(2):39-43.
[7] Varma PK,Neema PK. Hypertrophic cardiomyopathy Part 1-introduction, pathology and pathophysiology[J]. Ann Card Anaesth,2014,17(2):118424.
[8] Ho CY. Hypertrophic cardiomyopathy in 2012[J]. Circulation,2012,125(11):1432-4438.
[9] Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:Executive summary:A report of the American college of cardiology foundation/American heart association task force on practice guidelines[J]. Circulation,2011,124(24):2761-2796.
[10] Freites A, Canovas E, Rubio J. Electrocardiographic changes announcing the rapid development of apical hypertrophic cardiomyopathy in an adult male[J]. Ann Noninvasive Electrocardiol,2015,20(4):402-404.
[11] Hensley N,Dietrich J,Nyhan D,et al. Hypertrophic cardiomyopathy:A review[J].Anesth Analg,2015,120(3):554-569.
[12] Nampiaparampil RG,Swistel DG,Schlame M,et al. Intraoperative two-and three-dimensional transesophageal echocardiography in combined myectomy-mitral operations for hypertrophic cardiomyopathy[J]. J Am Soc Echocardiogr,2018,31(3):275-288.
[13] Naidu SS,Jacobson J, Iwai S, et al. Interventional therapies for relief of obstruction in hypertrophic cardiomyopathy:Discussion and proposed clinical algorithm[J]. Hosp Pract(1995),2018,46(2):58-63.
[14] Nishimura RA,Seggewiss H,Schaff HV. Hypertrophic obstructive cardiomyopathy:Surgical myectomy and septal ablation[J]. Circ Res,2017,121(7):771-783.
[15] Maron BJ. Clinical course and management of hypertrophic cardiomyopathy[J]. N Engl J med,2018,379(7):655-668.
[16] Jain A,Jain K,Bhagat H, et al. Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dualchamber pacemaker undergoing transurethral resection of the prostate[J]. Ann Card Anaesth,2010,13(3):246-248.
[17] Varma PK, Raman SP,Neema PK. Hypertrophic cardiomyopathy partⅡ—anesthetic and surgical considerations[J]. Ann Card Anaesth,2014,17(3):211-221.
[18] Hamatani Y,Amaki M,Kanzaki H,et al. Contrast-enhanced computed tomography with myocardial three-dimensional printing can guide treatment in symptomatic hypertrophic obstructive cardiomyopathy[J].ESC Heart Fail,2017,4(4):665-669.
[19] Hermsen JL,Burke TM,Seslar SP,et al. Scan,plan,print,practice,perform:Development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery[J]. J Thorac Cardiovas Surg,2017,153(1):132-440.
[20] Yee KF, Wasowicz M. Anaphylaxis and cardiac surgery for hypertrophic obstructive cardiomyopathy:A case report and review of anaesthetic management[J].Anaesthesiol Intensive Ther,2016,48(4):252-256.
[21] Sahoo RK,Dash SK, Raut PS, et al. Perioperative anesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery:A case series[J]. Ann Card Anaesth, 2010, 13(3):253-256.
[22] Xuan T, Zeng Y, Zhu WL. Risk of patients with hypertrophic cardiomyopathy undergoing noncardiac surgery[J]. Chin Med Sci J,2007,22(4):211-215.
[23] Haering JM,Comunale ME,Parker RA,et al. Cardiac risk of noncardiac surgery in patients with asymmetric septal hypertrophy[J].Anesthesiology, 1996,85(2):254-259.
[24] Kuroiwa M, Arai M, Ueno T, et al. Perioperative cardiovascular complications in patients with hypertrophic cardiomyopathy[J].Masui,2003,52(7):733-739.
[25] Hreybe H, Zahid M, Sonel A,et al. Noncardiac surgery and the risk of death and other cardiovascular events in patients with hypertrophic cardiomyopathy[J]. Clin Cardiol,2006, 29(2):65-68.
[26] Dhillon A, Khanna A, Randhawa MS, et al. Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoingon-cardiac surgery[J]. Heart, 2016,102(20):1627-4632.
[27] Edouard D,Pannier BM,London GM,et al. Venous and arterial behavior during normal pregnancy[J].Am J Physiol, 1998,274(5 Pt 2):H1605-1612.
[28] Vainrib A, Stergiopoulos K. Hypertrophic cardiomyopathy and pregnancy[J]. Minerva Ginecol,2012,64(5):399-407.
[29] Ashikhmina E, Farber MK, Mizuguchi KA. Parturients with hypertrophic cardiomyopathy:Case series and review of pregnancy outcomes and anesthetic management of labor and delivery[J].Int J Obstet Anesth,2015,24(4):344-355.
[30] Schinkel AF. Pregnancy in women with hypertrophic cardiomyopathy[J]. Cardiol Rev,2014,22(5):217-322.
[31] Furushima H, Chinushi M, Iijima K, et al. Ventricular tachyarrhythmia associated with hypertrophic cardiomyopathy:Incidence, prognosis, and relation to type of hypertrophy[J]. J Cardiovasc Electrophysiol,2010,21(9):991-999.
[32] Stergiopoulos K, Shiang E, Bench T. Pregnancy in patients with pre-existing cardiomyopathies[J]. J Am Coll Cardiol,2011,58(4):337-350.
[33] Langesaeter E, Dragsund M,Rosseland LA. Regional anaesthesia for a Caesarean section in women with cardiac disease:A prospective study[J]. Acta anaesthesiol Scand,2010,54(1):46-54.
[34] Pitton MA,Petolillo M,Munegato E,et al. Hypertrophic obstructive cardiomyopathy and pregnancy:Anesthesiological observations and clinical series[J]. Minerva anestesiol, 2007,73(5):313-318.
[35] Shin J,Kim M,Lee J,et al. Pregnancy in hypertrophic cardiomyopathy with severe left ventricular outflow tract obstruction[J].J Cardiovase Ultrasound,2016,24(2):158-462.
[36] DesRoches JM,McKeen DM,Warren A,et al. Anesthetic management guided by transthoracic echocardiography during cesarean delivery complicated by hypertrophic cardiomyopathy[J]. A A Case Rep,2016,6(6):154459.
[2] Vives M,Roscoe A. Hypertrophic cardiomyopathy:Implications for anesthesia[J]. Minerva anestesiol,2014,80(12):1310-1319.
[3] Seeger T,Shrestha R, Lam CK, et al. A premature termination codon mutation in MYBPC3 causes hypertrophic cardiomyopathy via chronic activation of nonsense-mediated decay[J]. Circulation,2019,139(6):799-811.
[4] Marian AJ,Braunwald E. Hypertrophic cardiomyopathy:Genetics,pathogenesis,clinical manifestations,diagnosis,and therapy[J].Circ Res,2017,121(7):749-770.
[5] Gajewski M,Hillel Z. Anesthesia management of patients with hypertrophic obstructive cardiomyopathy[J]. Prog Cardiovasc Dis,2012,54(6):503-511.
[6] Bradic Z,Ivanovic,B,Markovic D,et al. Preoperative preparation of patients with cardiomyopathies in non-cardiac surgery[J]. Acta Chir Iugosl,2011,58(2):39-43.
[7] Varma PK,Neema PK. Hypertrophic cardiomyopathy Part 1-introduction, pathology and pathophysiology[J]. Ann Card Anaesth,2014,17(2):118424.
[8] Ho CY. Hypertrophic cardiomyopathy in 2012[J]. Circulation,2012,125(11):1432-4438.
[9] Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:Executive summary:A report of the American college of cardiology foundation/American heart association task force on practice guidelines[J]. Circulation,2011,124(24):2761-2796.
[10] Freites A, Canovas E, Rubio J. Electrocardiographic changes announcing the rapid development of apical hypertrophic cardiomyopathy in an adult male[J]. Ann Noninvasive Electrocardiol,2015,20(4):402-404.
[11] Hensley N,Dietrich J,Nyhan D,et al. Hypertrophic cardiomyopathy:A review[J].Anesth Analg,2015,120(3):554-569.
[12] Nampiaparampil RG,Swistel DG,Schlame M,et al. Intraoperative two-and three-dimensional transesophageal echocardiography in combined myectomy-mitral operations for hypertrophic cardiomyopathy[J]. J Am Soc Echocardiogr,2018,31(3):275-288.
[13] Naidu SS,Jacobson J, Iwai S, et al. Interventional therapies for relief of obstruction in hypertrophic cardiomyopathy:Discussion and proposed clinical algorithm[J]. Hosp Pract(1995),2018,46(2):58-63.
[14] Nishimura RA,Seggewiss H,Schaff HV. Hypertrophic obstructive cardiomyopathy:Surgical myectomy and septal ablation[J]. Circ Res,2017,121(7):771-783.
[15] Maron BJ. Clinical course and management of hypertrophic cardiomyopathy[J]. N Engl J med,2018,379(7):655-668.
[16] Jain A,Jain K,Bhagat H, et al. Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dualchamber pacemaker undergoing transurethral resection of the prostate[J]. Ann Card Anaesth,2010,13(3):246-248.
[17] Varma PK, Raman SP,Neema PK. Hypertrophic cardiomyopathy partⅡ—anesthetic and surgical considerations[J]. Ann Card Anaesth,2014,17(3):211-221.
[18] Hamatani Y,Amaki M,Kanzaki H,et al. Contrast-enhanced computed tomography with myocardial three-dimensional printing can guide treatment in symptomatic hypertrophic obstructive cardiomyopathy[J].ESC Heart Fail,2017,4(4):665-669.
[19] Hermsen JL,Burke TM,Seslar SP,et al. Scan,plan,print,practice,perform:Development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery[J]. J Thorac Cardiovas Surg,2017,153(1):132-440.
[20] Yee KF, Wasowicz M. Anaphylaxis and cardiac surgery for hypertrophic obstructive cardiomyopathy:A case report and review of anaesthetic management[J].Anaesthesiol Intensive Ther,2016,48(4):252-256.
[21] Sahoo RK,Dash SK, Raut PS, et al. Perioperative anesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery:A case series[J]. Ann Card Anaesth, 2010, 13(3):253-256.
[22] Xuan T, Zeng Y, Zhu WL. Risk of patients with hypertrophic cardiomyopathy undergoing noncardiac surgery[J]. Chin Med Sci J,2007,22(4):211-215.
[23] Haering JM,Comunale ME,Parker RA,et al. Cardiac risk of noncardiac surgery in patients with asymmetric septal hypertrophy[J].Anesthesiology, 1996,85(2):254-259.
[24] Kuroiwa M, Arai M, Ueno T, et al. Perioperative cardiovascular complications in patients with hypertrophic cardiomyopathy[J].Masui,2003,52(7):733-739.
[25] Hreybe H, Zahid M, Sonel A,et al. Noncardiac surgery and the risk of death and other cardiovascular events in patients with hypertrophic cardiomyopathy[J]. Clin Cardiol,2006, 29(2):65-68.
[26] Dhillon A, Khanna A, Randhawa MS, et al. Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoingon-cardiac surgery[J]. Heart, 2016,102(20):1627-4632.
[27] Edouard D,Pannier BM,London GM,et al. Venous and arterial behavior during normal pregnancy[J].Am J Physiol, 1998,274(5 Pt 2):H1605-1612.
[28] Vainrib A, Stergiopoulos K. Hypertrophic cardiomyopathy and pregnancy[J]. Minerva Ginecol,2012,64(5):399-407.
[29] Ashikhmina E, Farber MK, Mizuguchi KA. Parturients with hypertrophic cardiomyopathy:Case series and review of pregnancy outcomes and anesthetic management of labor and delivery[J].Int J Obstet Anesth,2015,24(4):344-355.
[30] Schinkel AF. Pregnancy in women with hypertrophic cardiomyopathy[J]. Cardiol Rev,2014,22(5):217-322.
[31] Furushima H, Chinushi M, Iijima K, et al. Ventricular tachyarrhythmia associated with hypertrophic cardiomyopathy:Incidence, prognosis, and relation to type of hypertrophy[J]. J Cardiovasc Electrophysiol,2010,21(9):991-999.
[32] Stergiopoulos K, Shiang E, Bench T. Pregnancy in patients with pre-existing cardiomyopathies[J]. J Am Coll Cardiol,2011,58(4):337-350.
[33] Langesaeter E, Dragsund M,Rosseland LA. Regional anaesthesia for a Caesarean section in women with cardiac disease:A prospective study[J]. Acta anaesthesiol Scand,2010,54(1):46-54.
[34] Pitton MA,Petolillo M,Munegato E,et al. Hypertrophic obstructive cardiomyopathy and pregnancy:Anesthesiological observations and clinical series[J]. Minerva anestesiol, 2007,73(5):313-318.
[35] Shin J,Kim M,Lee J,et al. Pregnancy in hypertrophic cardiomyopathy with severe left ventricular outflow tract obstruction[J].J Cardiovase Ultrasound,2016,24(2):158-462.
[36] DesRoches JM,McKeen DM,Warren A,et al. Anesthetic management guided by transthoracic echocardiography during cesarean delivery complicated by hypertrophic cardiomyopathy[J]. A A Case Rep,2016,6(6):154459.