【摘要】 目的:探讨经皮室间隔心肌化学消融(PTSMA)酒精用量与围术期心肌损伤和心律失常发生的关系。方法:连续选择接受低剂量酒精(≤2ml)消融的肥厚型梗阻性心肌病(HOCM)患者10例(低剂量组),从资料库中筛选常规较大剂量酒精(>2ml)治疗的患者20例作为对照组,分别记录两组患者围术期血清肌酸激酶同工酶(CK-MB)峰值及心律失常的发生情况,同时评估两种剂量酒精对术后血流动力学和心脏结构的影响。结果:低剂量组和对照组PTSMA围术期CK-MB峰值分别为(126.9±55.3)U/L和(232.8±58.7)U/L(P<0.01);相关分析显示,CK-MB峰值与酒精剂量呈显著正相关(r=0.646,P<0.01);两组发生急性房室传导异常(含束支、室内传导和Ⅰ～Ⅲ度房室传导阻滞)分别为6例(60%)和13例(65%),发生Ⅲ度房室传导阻滞分别为2例(20%)和5例(25%);两组术后左心室流出道压力阶差(LVOTPG)和室间隔厚度较基线水平均显著下降(均P<0.01),但两组间术后LVOTPG水平及下降幅度均差异无统计学意义。结论:低剂量酒精能减少PTSMA围术期心肌坏死,并显著改善术后血流动力学和心脏结构,但不能减轻传导系统的损伤。更多还原

【Abstract】 Objective:To evaluate the beneficial effects of low-dose alcohol in pecutaneous transluminal septal myocardial ablation(PTSMA) for obstructive hypertrophic cardiomyopathy(HOCM).Method:A 1:2 matched case-control study was performed in our hospital.10 consecutive patients with HOCM received a small amount of alcohol(≤2 ml),and they were compared with 20 cases receving standard dose(>2 ml).Early results of myocardial infarct size and arrhythmias within perioperative period were determined by peak CK-MB and electrocardiogram.The resultant hemodynamic changes and left ventricular remodeling were also checked.Result:The CK-MB peak within peri-interventional period were(126.9±55.3)U/L and(232.8±58.7)U/L(P<0.01).There was a significant correlation between peak CK-MB and alcohol dose(r=0.646,P<0.01).Acute abnormalities in conduction system occurred in 6 patients(60%) from low-dose group and 13 patients(65%) from control group.Temporary post procedural complete atrioventricular block was identified in 2 patients(20%) from low-dose group and 5 patients(25%) from control group.Post-procedural LVOTPG and interventricular septum decreased significantly(P<0.01).But there was no significant difference in the level of Post-procedural LVOTPG and decreasing amplitude between the 2 groups.Conclusion:Low dose of alcohol minimize the myocardial infarct size,but can not eliminate or lower the occurrence of arrhythmias(mostly atrioventricular abnormalities) during the peri-interventional period.更多还原