改良扩大Morrow手术治疗肥厚梗阻性心肌病12例临床分析
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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:2013年1月至2017年5月,12例患者因肥厚梗阻性心肌病行外科手术治疗,男性8例、女性4例,年龄42～56,平均年龄(40±13.3)岁,体质量55～74 kg,平均(60±12.6)kg,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(改良扩大Morrow技术),合并主动脉瓣下隔膜切除术4例。围术期UCG或TEE评价左心房(LA)、左心室(LV)、左心室流出道流速及压差(LVOT)、LVEF、二尖瓣结构和功能。结果:体外循环时间82～110 min,平均(71±18.3)min,主动脉阻断时间50～96 min,平均(45±16.4)min,气管插管时间8～22 h,平均(12±13.6)h, ICU住院时间24～72 h,平均(36±23)h,术后住院时间10～14 d,平均(10.4±2.8)d。与术前相比,LA大小[(40±9)vs.(36±4)mm]、LVOT [(111±32)vs.(26±12)mmHg,1 mmHg=0.133 kPa]、室间隔厚度[(26±5)vs.(17±4)mm]、LVEF [(69±11)%vs.(58±8)%]均显著下降(P<0.05)。二尖瓣关闭好或仅轻度反流,SAM征消失。主要并发症:完全性房室传导阻滞1例(安装永久起搏器)。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心室流出道梗阻,提高患者的生命质量。
Objective: To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy(HOCM).Method From January 2013 to May 2017,12 HOCM patients underwent surgical treatment.There were 8 males and 4 females ranging from 42-56 years old(40±13.3)with body weight 55～74(60±12.6) kg.Operation was performed under general anesthesia and cardiopulmonary bypass(CPB) wth the modcrate systemic temperature and low volume blood flow. Preoperative and postoperative left ventricular(LV),left yentricular oudlow tract(LVOT),left atrium(LA),mitral valve function and value of LVEF were evaluated by transesophageal echocardiograph examination.Result : The time of CPB and aortic occlusion were 82-110 minutes(71±18.3)and 50-96 min(45±16.4)respectively.The endotracheal intubation durations were 8-22 hours(12±13.6)and ICU duration 24-72 hours(36±23)h.Comparing with the pre-operative echocardiographic parameters,the size of left atrium [(40±9) vs.(36±4)mm],pressure gradients throush LVOT[(111±32) vs.(26±12) mm Hg).the thickness of septum ](26±5) vs.(17±4) mm] and the value of EF[(69±11)% vs.(58±8)%]obviouslv decreased postoperatively(P<0.05). The surviving patients had either no mitral valve regurgitation or only mild mitral valve regurgiratitation.There were 1 patients with a complete AV block postoperatively and 1 were implanted permanent pacemakers. Conclusions: Surgical outcome for HOCM patients is satisfactory.Most HOCM patients achieve such a satisfactory relief of LV out ract obstruction as to lead a better life.
Objective: To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy(HOCM).Method From January 2013 to May 2017,12 HOCM patients underwent surgical treatment.There were 8 males and 4 females ranging from 42-56 years old(40±13.3)with body weight 55～74(60±12.6) kg.Operation was performed under general anesthesia and cardiopulmonary bypass(CPB) wth the modcrate systemic temperature and low volume blood flow. Preoperative and postoperative left ventricular(LV),left yentricular oudlow tract(LVOT),left atrium(LA),mitral valve function and value of LVEF were evaluated by transesophageal echocardiograph examination.Result : The time of CPB and aortic occlusion were 82-110 minutes(71±18.3)and 50-96 min(45±16.4)respectively.The endotracheal intubation durations were 8-22 hours(12±13.6)and ICU duration 24-72 hours(36±23)h.Comparing with the pre-operative echocardiographic parameters,the size of left atrium [(40±9) vs.(36±4)mm],pressure gradients throush LVOT[(111±32) vs.(26±12) mm Hg).the thickness of septum ](26±5) vs.(17±4) mm] and the value of EF[(69±11)% vs.(58±8)%]obviouslv decreased postoperatively(P<0.05). The surviving patients had either no mitral valve regurgitation or only mild mitral valve regurgiratitation.There were 1 patients with a complete AV block postoperatively and 1 were implanted permanent pacemakers. Conclusions: Surgical outcome for HOCM patients is satisfactory.Most HOCM patients achieve such a satisfactory relief of LV out ract obstruction as to lead a better life.
引文
[1] 薛智敏,周斌全.经皮腔内间隔心肌化学消融术治疗肥厚性梗阻性心肌病临床分析[J].中西医结合心血管病电子杂志,2016,(4)4:83-84.
[2] 孙丽.肥厚梗阻性心肌病化学消融疗效观察[J].中国保健营养(下旬刊),2014,,24(3):1231-1232.
[3] 古平.起搏治疗肥厚梗阻性心肌病的临床研究[J].现代中西医结合杂志,2013,22(27):3018-3020.
[4] 崔彬,许建屏,王巍,等.肥厚型梗阻性心肌病围术期心律失常特点及治疗策略[J].中国循环杂志,2011,26(2):129-132.
[5] 刘纯丽,王彬.浅谈经皮腔内间隔心肌化学消融术治疗肥厚性梗阻性心肌病临床分析[J].心血管病防治知识(下半月),2015,4:95-97.
[6] 王海峰,陈绪发,周丹,等.扩大室间隔切除治疗肥厚型梗阻性心肌病的临床研究[J].中国心血管病研究,2012,10(10):730-733.
[7] 孙宏涛,王水云,罗明尧,等.隐匿性肥厚梗阻性心肌病的外科治疗[J].中国分子心脏病学杂志,2012,12(2):65-67.
[8] 然鋆,宋云虎,胡盛寿,等.改良Morrow术治疗经皮室间隔消融术后的肥厚型梗阻性心肌病[J].中国分子心脏病学杂志,2017,17(2):2009-2011.
[9] 唐亚杰,宋云虎,王水云,等.改良扩大Morrow手术治疗主动脉瓣下梗阻合并左心室中部梗阻的肥厚型梗阻性心肌病中期效果分析[J].中国循环杂志,2016,31(6):578-582.
[10] 宋云虎.Morrow 手术治疗肥厚型梗阻性心肌病 719 例疗效分析[J].中国循环杂志(增刊),2015,30:86.
[11] 李浩杰,宋云虎,朱晓东,等.单中心室间隔心肌切除术治疗肥厚型梗阻性心肌病中远期结果分析[J].中国循环杂志,2016,31(6):573-577.
[12] 简宇鹏,孙培吾,区景松,等.肥厚型心肌病诊治进展[J].心血管外科杂志(电子版),2016,5(1):31-36.
[13] 邓素叶,尚海凤,杨启伟,等.彩色多普勒超声诊断非梗阻型右室肥厚性心肌病1例[J].内蒙古中医药,2013,32(1):82-83.
[14] 罗明尧,王水云,尹朝华,等.合并感染性心内膜炎肥厚梗阻性心肌病的外科治疗[J].中国胸心血管外科临床杂志,2012,19(6):597-601.
[15] 邹爱春,孙志彬.21例心尖肥厚型心肌病临床分析[J].中国心血管病研究杂志,2004,2(5):364-365.
[16] 李轩,徐飞,于冰,等.肥厚梗阻性心肌病合并二尖瓣狭窄的外科治疗[J].心肺血管病杂志,2017,36(4):273-276.
[17] 汪烨,姜腾勇,韩智红,等.肥厚型心肌病患者的生存分析[J].心肺血管病杂志,2011,30(3):222-225.
[18] 杨建国,陈绪发,何亚峰,等.外科治疗肥厚型梗阻性心肌病的疗效评价[J].心肺血管病杂志,2015,34(6):461-464.
[2] 孙丽.肥厚梗阻性心肌病化学消融疗效观察[J].中国保健营养(下旬刊),2014,,24(3):1231-1232.
[3] 古平.起搏治疗肥厚梗阻性心肌病的临床研究[J].现代中西医结合杂志,2013,22(27):3018-3020.
[4] 崔彬,许建屏,王巍,等.肥厚型梗阻性心肌病围术期心律失常特点及治疗策略[J].中国循环杂志,2011,26(2):129-132.
[5] 刘纯丽,王彬.浅谈经皮腔内间隔心肌化学消融术治疗肥厚性梗阻性心肌病临床分析[J].心血管病防治知识(下半月),2015,4:95-97.
[6] 王海峰,陈绪发,周丹,等.扩大室间隔切除治疗肥厚型梗阻性心肌病的临床研究[J].中国心血管病研究,2012,10(10):730-733.
[7] 孙宏涛,王水云,罗明尧,等.隐匿性肥厚梗阻性心肌病的外科治疗[J].中国分子心脏病学杂志,2012,12(2):65-67.
[8] 然鋆,宋云虎,胡盛寿,等.改良Morrow术治疗经皮室间隔消融术后的肥厚型梗阻性心肌病[J].中国分子心脏病学杂志,2017,17(2):2009-2011.
[9] 唐亚杰,宋云虎,王水云,等.改良扩大Morrow手术治疗主动脉瓣下梗阻合并左心室中部梗阻的肥厚型梗阻性心肌病中期效果分析[J].中国循环杂志,2016,31(6):578-582.
[10] 宋云虎.Morrow 手术治疗肥厚型梗阻性心肌病 719 例疗效分析[J].中国循环杂志(增刊),2015,30:86.
[11] 李浩杰,宋云虎,朱晓东,等.单中心室间隔心肌切除术治疗肥厚型梗阻性心肌病中远期结果分析[J].中国循环杂志,2016,31(6):573-577.
[12] 简宇鹏,孙培吾,区景松,等.肥厚型心肌病诊治进展[J].心血管外科杂志(电子版),2016,5(1):31-36.
[13] 邓素叶,尚海凤,杨启伟,等.彩色多普勒超声诊断非梗阻型右室肥厚性心肌病1例[J].内蒙古中医药,2013,32(1):82-83.
[14] 罗明尧,王水云,尹朝华,等.合并感染性心内膜炎肥厚梗阻性心肌病的外科治疗[J].中国胸心血管外科临床杂志,2012,19(6):597-601.
[15] 邹爱春,孙志彬.21例心尖肥厚型心肌病临床分析[J].中国心血管病研究杂志,2004,2(5):364-365.
[16] 李轩,徐飞,于冰,等.肥厚梗阻性心肌病合并二尖瓣狭窄的外科治疗[J].心肺血管病杂志,2017,36(4):273-276.
[17] 汪烨,姜腾勇,韩智红,等.肥厚型心肌病患者的生存分析[J].心肺血管病杂志,2011,30(3):222-225.
[18] 杨建国,陈绪发,何亚峰,等.外科治疗肥厚型梗阻性心肌病的疗效评价[J].心肺血管病杂志,2015,34(6):461-464.