中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
2期
110-113
,共4页
罗明尧%王水云%宋云虎%尹朝华%孙宏涛%孙欣%徐楠%许建屏%王巍%胡盛寿
囉明堯%王水雲%宋雲虎%尹朝華%孫宏濤%孫訢%徐楠%許建屏%王巍%鬍盛壽
라명요%왕수운%송운호%윤조화%손굉도%손흔%서남%허건병%왕외%호성수
心肌病,肥厚性%心脏外科手术%扩大Morrow手术%肌切除术
心肌病,肥厚性%心髒外科手術%擴大Morrow手術%肌切除術
심기병,비후성%심장외과수술%확대Morrow수술%기절제술
Cardiomyopathy,hypertrophic%Cardiac surgical procedures%Extended Morrow procedure%Myectomy
目的 总结外科手术治疗118例肥厚型梗阻性心肌病(HOCM)的早中期疗效.方法 回顾性分析2009年10月至2012年4月阜外心血管病医院手术治疗的118例HOCM患者,其中男69例,女49例,平均年龄(46 ± 13)岁,全组均在全麻低温体外循环下行扩大Morrow手术,术前、术后常规行经胸超声心动图检查,术中常规行经食管超声心动图检查.根据术前查明的心脏合并疾病,必要时同期施行相应的手术治疗.结果 本组患者术前室间隔最大厚度为(25 ±7)mm,二尖瓣收缩期前向运动(SAM)现象阳性率100％.全组无术中死亡,术后30 d病死率0.8％(1/118),死亡原因为术后低心排综合征导致的多器官功能衰竭.手术前后LVOT峰值压差平均为(92±22)和(13±10)mm Hg(1 mm Hg=0.133 kPa,P=0.000),心功能NYHA分级分别为2.9±0.6和1.2±0.4(P=0.000).术后除l例患者仍存在轻度SAM现象外,余均消失；二尖瓣均为无反流、微量或者少量反流.同期进行其他心脏手术45例(38.1％).术后主要并发症包括完全性房室传导阻滞3例,一度房室传导阻滞6例,完全性左束支传导阻滞51例,室内阻滞或左前分支阻滞26例,二次开胸止血3例,一过性急性肾功能衰竭2例,需主动脉球囊反搏支持2例.本组术后随访1 ～ 27个月,平均(7±6)个月,患者生活质量改善,心功能均为Ⅰ～Ⅱ级,无死亡或再次手术.结论 外科手术治疗HOCM安全有效.根据其解剖特点,严格实施各部位的外科操作,能够有效地解除左心室流出道梗阻,可重复性好.
目的 總結外科手術治療118例肥厚型梗阻性心肌病(HOCM)的早中期療效.方法 迴顧性分析2009年10月至2012年4月阜外心血管病醫院手術治療的118例HOCM患者,其中男69例,女49例,平均年齡(46 ± 13)歲,全組均在全痳低溫體外循環下行擴大Morrow手術,術前、術後常規行經胸超聲心動圖檢查,術中常規行經食管超聲心動圖檢查.根據術前查明的心髒閤併疾病,必要時同期施行相應的手術治療.結果 本組患者術前室間隔最大厚度為(25 ±7)mm,二尖瓣收縮期前嚮運動(SAM)現象暘性率100％.全組無術中死亡,術後30 d病死率0.8％(1/118),死亡原因為術後低心排綜閤徵導緻的多器官功能衰竭.手術前後LVOT峰值壓差平均為(92±22)和(13±10)mm Hg(1 mm Hg=0.133 kPa,P=0.000),心功能NYHA分級分彆為2.9±0.6和1.2±0.4(P=0.000).術後除l例患者仍存在輕度SAM現象外,餘均消失；二尖瓣均為無反流、微量或者少量反流.同期進行其他心髒手術45例(38.1％).術後主要併髮癥包括完全性房室傳導阻滯3例,一度房室傳導阻滯6例,完全性左束支傳導阻滯51例,室內阻滯或左前分支阻滯26例,二次開胸止血3例,一過性急性腎功能衰竭2例,需主動脈毬囊反搏支持2例.本組術後隨訪1 ～ 27箇月,平均(7±6)箇月,患者生活質量改善,心功能均為Ⅰ～Ⅱ級,無死亡或再次手術.結論 外科手術治療HOCM安全有效.根據其解剖特點,嚴格實施各部位的外科操作,能夠有效地解除左心室流齣道梗阻,可重複性好.
목적 총결외과수술치료118례비후형경조성심기병(HOCM)적조중기료효.방법 회고성분석2009년10월지2012년4월부외심혈관병의원수술치료적118례HOCM환자,기중남69례,녀49례,평균년령(46 ± 13)세,전조균재전마저온체외순배하행확대Morrow수술,술전、술후상규행경흉초성심동도검사,술중상규행경식관초성심동도검사.근거술전사명적심장합병질병,필요시동기시행상응적수술치료.결과 본조환자술전실간격최대후도위(25 ±7)mm,이첨판수축기전향운동(SAM)현상양성솔100％.전조무술중사망,술후30 d병사솔0.8％(1/118),사망원인위술후저심배종합정도치적다기관공능쇠갈.수술전후LVOT봉치압차평균위(92±22)화(13±10)mm Hg(1 mm Hg=0.133 kPa,P=0.000),심공능NYHA분급분별위2.9±0.6화1.2±0.4(P=0.000).술후제l례환자잉존재경도SAM현상외,여균소실；이첨판균위무반류、미량혹자소량반류.동기진행기타심장수술45례(38.1％).술후주요병발증포괄완전성방실전도조체3례,일도방실전도조체6례,완전성좌속지전도조체51례,실내조체혹좌전분지조체26례,이차개흉지혈3례,일과성급성신공능쇠갈2례,수주동맥구낭반박지지2례.본조술후수방1 ～ 27개월,평균(7±6)개월,환자생활질량개선,심공능균위Ⅰ～Ⅱ급,무사망혹재차수술.결론 외과수술치료HOCM안전유효.근거기해부특점,엄격실시각부위적외과조작,능구유효지해제좌심실류출도경조,가중복성호.
Objective To assess the clinical outcomes of transaortic extended septal myectomy on early and midterm survival of patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods From October 2009 to April 2012,118 consecutive patients underwent extended Morrow's procedure for HOCM.There were 69 males and 49 females with an average age of (46 ±± 13) years.Their clinical data were analyzed retrospectively.Preoperative transthoracic,intraoperative transoesophageal and postoperative transthoracic echocardiography was performed to assess septal thickness,left ventricular outflow tract (LVOT) gradient,mitral valve function and systolic anterior motion (SAM) of anterior mitral valve leaflet,etc.Concomitant surgical procedures were performed if other cardiac diseases required surgical interventions.Follow-up study was carried out during subsequent clinic visits at outpatient department and through telephone interviews with patients and their relatives.Results The septal thickness was (25 ± 7)mm.SAM was detected in all.The in-hospital mortality was 0.8％ (1/118) since one patient died of multiple organs failure one week later.Postoperative echocardiography demonstrated marked reduction in LVOTgradient (92±22 vs 13 ± 10 mm Hg (1 mm Hg=0.133 kPa),P =0.000),New York Heart Association (NYHA) class (2.9 ± 0.6 vs 1.2± 0.4,P =0.000) and significant improvement in mitral regurgitation.Concomitant surgical procedures were performed in 45 cases (38.1％,all for preexisting conditions).Complications included complete atrioventricular block (n =3),first degree atrioventricular block (n =6),complete left bundle branch block (n =51),intraventricular conduction delay or left anterior division block (n =26),transient renal dysfunction (n =2) and intra-aortic-balloon-pumping (n =2).No other severe complication was observed.During a follow-up period of 1-27 (7 ± 6) months,there was no readmission or death.All patients reported significant increase in physical ability and obvious decrease in limiting symptoms.At the latest follow-up,the NYHA functional class maintained grade Ⅰ-Ⅱ in all.And mitral regurgitation remained absent or mild.Conclusion Surgical procedure for HOCM patients is both safe and efficacious.It provides an excellent relief of LVOT obstruction.
