【摘要】 目的 :总结60岁以上合并高血压的老年肥厚型梗阻性心肌病(HOCM)患者与无高血压的老年HOCM患者行经皮室间隔心肌化学消融术(PTSMA)治疗的近期(≤30天)疗效及并发症发生情况。方法 :对1998-07至2013-07实施PTSMA治疗的44例60岁以上老年患者的临床资料和化学消融结果进行回顾性分析,总结合并高血压的HOCM患者(合并高血压HOCM组)23例及无高血压的HOCM患者(无高血压HOCM组)21例行PTSMA近期疗效和术中、术后围术期并发症的发生情况,探讨60岁以上老年HOCM患者行PTSMA的疗效及安全性。结果 :合并高血压的老年HOCM患者23例,其中22例接受PTSMA治疗,术后比术前静息及早搏后左心室流出道压力阶差明显下降[(12.27±10.18)mmHg vs(66.95±35.21)mmHg,(39.95±16.82)mmHg vs(115.32±32.86)mmHg,P均<0.01];无高血压HOCM组21例患者接受PTSMA治疗,术后比术前静息及早搏后左心室流出道压力阶差亦明显下降[(17.81±20.73)mmHg vs(75.43±46.50)mmHg,(39.24±23.74)mmHg vs(133.19±48.76)mmHg,P均<0.01]。两组术前后静息及早搏后左心室流出道压力阶差变化值无明显差异[(⊿54.68±31.31)mmHg vs(⊿56.19±39.11)mmHg,P=0.889;(⊿75.36±32.05)mmHg vs(⊿93.95±41.63)mmHg,P=0.108]。两组总并发症发生率无明显差异(52.2%vs47.6%,P=0.763),两组严重并发症(包括死亡、Ⅲ度房室传导阻滞、急性左心衰竭)发生率差异无统计学意义(30.4%vs14.3%,P=0.202)。合并高血压HOCM组≥70岁的老年HOCM患者死亡率明显高于无高血压HOCM组患者(P=0.034)。结论 :合并高血压的老年HOCM患者与无高血压的老年HOCM患者对无水酒精行PTSMA治疗均有明显疗效,但合并高血压的70岁以上老年HOCM患者行PTSMA时更易出现较严重并发症,故对这部分患者施行PTSMA应谨慎。更多还原

【Abstract】 Objective: To summarize the efficacy and safety for percutaneous transluminal septal myocardial ablation(PTSMA) in patients elder than 60 years of hypertrophic obstructive cardiomyopathy(HOCM) with or without hypertension.Methods: We retrospectively studied 44 HOCM patients at the age ≥ 60years who received PTSMA in our hospital from 1998-07 to 2013-07. The patients were divided into 2 groups, Combining hypertension group, n =23 and Not combining hypertension group, n=21. The complications during, at peri-operative period with immediate(≤30days) efficacy and safety of PTSMA were compared between 2 groups.Results: In Combining hypertension group, there was 22/23 patients presented decreased left ventricular outflow tract pressure gradient(LVOTPG) at the rest and post premature beat after the operation than they were before(12.27±10.18 vs 66.95±35.21) mmHg and(39.95±16.82 vs 115.32±32.86) mmHg, both P<0.01. Not combining hypertension group also showed decreased LVOTPG at the rest and post premature beat after the operation(17.81±20.73 vs 75.43±46.50) mmHg and(39.24±23.74 vs 133.19±48.76) mmHg, both P<0.01. The changing value of LVOTPG were similar between 2 groups( ⊿54.68±31.31 vs ⊿ 56.19±39.11) mmHg, P=0.889 and(⊿75.36±32.05 vs ⊿ 93.95±41.63) mmHg, P=0.108. The total complication rate and severe complication rate(including death, III°atrio-ventricular block, acute left ventricular heart failure) were similar between 2 groups(52.2% vs 47.6%, P=0.763) and(30.4% vs 14.3%, P=0.202). The patients at the age ≥ 70 years in Combining hypertension group had the higher mortality than those in Not combining hypertension group, P=0.034.Conclusion: PTSMA was an effective treatment for HOCM patients with or without hypertension, while the patients at the age ≥ 70 years had more risk for severe complications, therefore special attention should concentrated in such patients.更多还原