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心脏起搏治疗梗阻性肥厚型心肌病远期临床及血液动力学观察 |
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陈振云1 熊海刚1 裘哲君1 张国元2 吴宗贵2 洪中立3 闵宗延4
摘要 为观察右室起搏对梗阻性肥厚型心肌病(HOCM)患者的远期疗效。采用有创的血液动力学监测方法观察26例患者右室起搏前、后血液动力学变化。该组患者右室起搏3年后收缩期二尖瓣前向运动程度、左室流出道血流速度及压力阶差、左室舒张末压、心输出量及心脏指数均显著改善〔2.51±0.61级 vs 3.56±0.45级，2.5±1.1 m/s vs 4.7±1.2 m/s，5.03±2.98 kPa vs 13.16±6.20 kPa，1.08±0.79 kPa vs 3.30±1.21 kPa, 5.96±1.54 L/min vs 4.33±1.36 L/min，3.31±0.76 L/(m2*min) vs 2.30±0.39 L/(m2*min),P均<0.001〕，其远期疗效明显。结果提示对药物治疗无效或疗效不满意的HOCM病人可采用起搏治疗。
关键词 肥厚型心肌病，梗阻性 心脏起搏 血液动力学
A Study of Long-Term Clinic and Hemodynamics of Hypertrophic Obstructive Cardiomyopathy
During Right Ventricular Pacing
Chen Zhenyun，Xiong Haigang,Qiu Zhejun,et al
(The 113th Hospital of PLA,Ningbo，315040)
Abstract For observing long-term effection of right ventricular pacing on hypertrophic obstructive cardiomyopathy (HOCM),Hemodynomic changes of the patients with HOCM before and after right ventricular pacing were observed by invasive hemodynomic surveillance.After 26 patients with HOCM treated with right ventricular pacing for three years,systolic anterior motion of the mitral valve leaflet(SAM),left ventricular outflow tract blood velocity and pressure gradient,left ventricular diastolic end pressure,cardiac output and index were significantly improved 〔2.51±0.61 degree vs 3.56±0.45 degree,2.5±1.1 m/s vs 4.7±1.2 m/s,5.03±2.98 kPa vs 13.16±6.20 kPa,1.08±0.79 kPa vs 3.30±1.21 kPa,5.96±1.54 L/min vs 4.33±1.36 L/min,3.31±0.76 L/(m2*min) vs 2.30±0.39 L/(m2*min),P<0.001,respectively〕.Conclusion: It is notable that the long-term effection of the patients with HOCM were treated by right ventricular pacing,therefore it would be proable alternation treatment to surgery for patients with HOCM.
Key word Hypertrophic obstructive cardiomyopathy Cardiac pacing Hemodynamics
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