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目的:总结原发性肥厚型梗阻性心肌病(HOCM)患者行经皮室间隔心肌化学消融术(PTSMA)治疗并发症的发生情况,探讨其相关危险因素。方法:入选实施PTSMA治疗的HOCM患者237例,对其临床资料和化学消融结果进行分析,总结PTSMA术中、术后围术期并发症的发生情况及18个月临床随访情况。结果:术后静息及期前收缩后左心室流出道压力阶差较术前明显下降[静息:(15.78±18.80)mmHg︰(67.02±36.87)mmHg;期前收缩后:(40.09±22.40)mmHg︰(119.02±39.80)mmHg;均P<0.01]。Logistic多因素回归分析显示,高血压为严重并发症(包括死亡、心肌梗死、Ⅲ度房室传导阻滞、心室颤动、休克、急性左心衰竭、股动脉假性动脉瘤)独立的相关危险因素(r=3.610,P=0.008)。18个月临床随访:21例胸闷、气促症状复发,20例经强化药物治疗后好转,1例症状无明显改善再次行化学消融治疗后好转;1例心力衰竭急性加重死亡。结论:化学消融治疗HOCM临床有效,但高血压是HOCM患者行PTSMA的独立危险因素。部分术后症状复发的病例,经强化药物治疗大部分症状缓解,症状不缓解者可行二次化学消融,仍可取得明显疗效。
Objective: To summarize the incidence of complications of percutaneous transluminal myocardial chemical ablation (PTSMA) in patients with primary hypertrophic obstructive cardiomyopathy (HOCM) and to explore the related risk factors. Methods: A total of 237 HOCM patients undergoing PTSMA were enrolled in this study. The clinical data and the results of chemical ablation were analyzed. The incidence of perioperative complications and postoperative follow-up of 18 months were summarized. Results: The difference of postoperative left ventricular outflow tract pressure and resting pressure was significantly lower than that before operation (resting: (15.78 ± 18.80) mmHg: (67.02 ± 36.87) mmHg; premature contractions: (40.09 ± 22.40 ) mmHg: (119.02 ± 39.80) mmHg; all P <0.01]. Logistic multivariate regression analysis showed that hypertension was an independent risk factor for severe complications (including death, myocardial infarction, grade III atrioventricular block, ventricular fibrillation, shock, acute left heart failure, femoral pseudoaneurysm) (r = 3.610, P = 0.008). 18 months clinical follow-up: 21 cases of chest tightness, recurrence of symptoms of shortness of breath, 20 cases improved after treatment with intensive drugs, 1 case of no significant improvement in chemotherapy again after the improvement of chemotherapy; 1 case of acute exacerbation of heart failure. Conclusion: Chemical ablation of HOCM is clinically effective, but hypertension is an independent risk factor for PTSMA in HOCM patients. Some cases of postoperative recurrence of symptoms, the majority of symptoms were relieved by intensive drug treatment, symptoms may not be relieved by the second chemical ablation, can still achieve significant results.