| | | 经皮室间隔心肌化学消融治疗12例肥厚型梗阻性心肌病的近期疗效观察
| | 中药学毕业论文【摘要】 目的中药学毕业论文 对我院采用经皮室间隔心肌化学消融（PTSMA）方法治疗的中药学毕业论文12例肥厚型梗阻性心肌病（HOCM）做近期疗效观察。方法 12例肥厚型梗阻性心肌病患者，男8例，女4例；平均年龄（38.6±12）岁；病程1~10年；均在术前接受过β受体阻滞剂和（或）钙拮抗剂治疗效果不佳。采用RAO 30°~45°体位投照下，确定靶血管后，向球囊导管中心腔内注入无水酒精，同时密切观察患者的心电图以及LVOTG的变化。所有患者术后均复查超声心动图，随访观察6个月。结果 12例患者中消融第一间隔支者8例，消融第二间隔支者2例，同时消融第一、二间隔支者2例。术中出现窦性心动过缓3例，完全性右束支传导阻滞8例，频发室性早搏6例，均为一过性，无严重并发症（高度房室传导阻滞）发生。术后3例心脏杂音完全消失，9例心脏杂音减轻Ⅰ~Ⅱ级。术后超声心动图均提示原先肥厚的室间隔心肌变薄，搏动减弱，LVOTG下降，SAM现象消失，左室射血分数提高。结论 PTSMA是通过PTCA技术经导管向供应肥厚室间隔心肌的间隔支动脉内注入无水酒精引起局灶性心肌梗死以达到缓解左室流出道梗阻的一种新技术。本组12例患者术后的症状、体征以及超声心动图表现均较术前有显著改善，无严重并发症出现。这表明PTSMA是一种治疗HOCM的有效方法，其近期疗效可靠，远期疗效尚待进一步观察。
【关键词】 肥厚型梗阻性心肌病；经皮室间隔心肌化学消融术
【Abstract】 Objective To observe the curative effect of PTSMA in 12 HOCM patients in the near future. Methods 12 HOCM patients（8 men，4 women，mean age 38.6±12 years），whose course of disease were 1~10 years. They had all received drug therapy such as β-blockers and/or calcium antagonists with less therapeutic efficacy. After determine the target vessel under RAO 30°~45°，absolute alcohol was injected into the septal branch through the central lumen of balloon catheter. ECG and LVOTG should be observed closely at the same time. Each of them will take an echocardiogram after the procedure and will be followed-up for six months.Results 8 of them were performed in the first septal branch，2 were in the second septal branch，the remaining 2 cases were peformed in both vessels. During the procedure，sinus bradycardia were occurrenced in 3 patients，8 with CRBBB and 6 with PVC frequently，but all of this were temporarily. The cardiac murmur were disappeared completely in 3 cases，9 were attenuated I~II class than before. After the procedure，the echocardiogram showed that the hypertrophic myocardium of ventricular septum was thinner and weaken，and the LOVTG was decreased，the SAM phenomenon was disappeared and the LVEF was increased.Conclusion PTSMA is a new kind of technology，which is using the technique of PTCA ，can cause focal myocardial infarction by injecting the absolute alcohol into the septal branch. In this group，the symptom， physical sign and the appearance of echocardiogram of the 12 patients were significantly improved after the procedure. There won’t any severe complication in this group. It seemd PTSMA is an effective way to treat HOCM，the effect is reliable in the near future，but the prospective efficacy is still need to be observed further more.
【Key words】 hypertrophic obstructive cardiomyopathy；percutaneous transluminal septal myocardial ablation
肥厚型梗阻性心肌病（hypertrophic obstructive cardiomyopathy， HOCM）是以室间隔非对称性肥厚和左心室流出道（left ventricle outflow tract， LVOT）梗阻为临床表现的一种疾病。经皮导管室间隔心肌化学消融术（percutaneous transluminal septal myocardial ablation， PTSMA）由Sigwart于1995年率先报道［1］，近年来国内外已逐步开展。它主要是通过介入的手段，在供应室间隔心肌血运的一支或数支间隔支动脉内注入无水酒精，使肥厚的心肌组织缺血坏死，从而减轻甚至消除左心室流出道的梗阻，以缓解症状，改善心功能。现将我院采用化学消融的方法治疗的12例肥厚型梗阻性心肌病及其近期疗效观察报告如下。
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