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本文叙述β阻滞剂、钙拮抗剂、抗心律失常药以及外科手术疗法对肥厚型心肌病(HCM)的治疗评价和利弊关系。β阻滞剂能抑制心脏交感神经兴奋性,减慢心率,降低左室收缩,可以明显改善 HCM 的症状,普萘洛尔或阿替洛尔的使用剂量应该个体化。维拉帕米能减轻心肌氧耗量和改善左室舒张功能,硝苯啶、地尔硫(艹卓)、尼卡地平也是治疗 HCM 的有效药物。有时β阻滞剂和钙拮抗剂的联合用药能取得更好疗效。HCM 伴有明显室性心律失常时推荐使用胺碘达隆治疗。左室流出道压力阶差≥50mmHg 的 HCM 病人,应予作室间隔部分肌切除术或室间隔上肌分离扩大术。HCM 中进行二尖瓣换置术要慎重考虑,外科手术不能降低 HCM 后期心源性猝死的发生率。
This article describes the beta blockers, calcium antagonists, antiarrhythmic drugs and surgical treatment of hypertrophic cardiomyopathy (HCM) evaluation of treatment and the pros and cons. Beta blockers can inhibit cardiac sympathetic nerve excitability, heart rate and reduce left ventricular contraction, can significantly improve the symptoms of HCM, propofol or atenolol should be used at a dose. Verapamil can reduce myocardial oxygen consumption and improve left ventricular diastolic function, nifedipine, diltiazem (艹 Zhuo), nicardipine is also an effective drug for the treatment of HCM. Sometimes beta blockers and calcium antagonist combination can achieve better efficacy. Amiodarone is recommended for HCM with significant ventricular arrhythmias. Left ventricular outflow tract pressure gradient HCM patients ≥ 50mmHg, should be part of myomectomy or ventricular septal muscle enlargement. HCM in mitral valve replacement surgery should be carefully considered, surgery can not reduce the incidence of post-HCM sudden cardiac death.