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目的长QT综合征(LQTS)是指具有心电图上QT间期延长,T波异常,易产生室性心律失常,尤其是尖端扭转性室性心动过速(TdP),晕厥和猝死的一组综合征。LQTS的治疗主要依靠药物。本研究的目的是观察左侧心交感神经切除手术(LCSD)方法对LQTS的治疗效果。方法对5例 LQTS患者行LCSD手术。评价病人手术前后的心电图和临床症状等情况。结果所有病人的LCSD手术均成功。术后的QTc值由术前的(0．59±0．05)s下降到(0．48±0．04)s(P=0．006．n=5)。同时,发现手术后LQTS患者心电图上U波逐渐显著的现象。(1)所有病人24 h内的平均QTc值均有不同程度的降低;(2)最大心率(HR)由术前的(103±17)次／min略下降到(96±15)次／min,而最小心率由(42± 7)次／min略升高到(46±5)次／min;(3)术前运动试验可引起某些导联上的T波形态明显改变,而术后这些改变消失或减轻;(4)术后运动试验期间所能达到的最大心率明显下降,由术前的(162±4)次／min 降低到(129±10)次／min(P=0．006,n=4);(5)5例病人术后跟踪随访15个月,只有1例患者在凌晨睡眠中有2次短暂晕厥发作,该患者术后服普萘洛尔量只有20mg(0．3 mg／kg)每日1次。其余患者皆无症状,服药情况为:2例近1年未服药,1例20 mg每日2次,1例10 mg每日3次。结论LCSD对药物不能控制的LQTS患者是一种安全、有效的疗法。相对于ICD昂贵的费用,LCSD的费用低廉、手术过程简单,因此对于象中国这样的发展中国家的LQTS患者来讲可能具有重要意义。
Objective Long QT syndrome (LQTS) refers to a set of ECG with a prolonged QT interval, T wave abnormalities, easy to produce ventricular arrhythmias, especially the torsades de pointes (TdP), a combination of syncope and sudden death Levy LQTS treatment depends mainly on the drug. The purpose of this study was to observe the therapeutic effect of left ventricular sympathectomy (LCSD) on LQTS. Methods 5 cases of LQTS patients underwent LCSD surgery. Evaluation of patients before and after surgery, ECG and clinical symptoms and so on. Results All patients underwent LCSD surgery successfully. The postoperative QTc decreased from (0.59 ± 0.05) s to (0.48 ± 0.04) s before surgery (P = 0.006, n = 5). At the same time, it was found that the U wave on the ECG of patients with LQTS after operation gradually became obvious. (1) The mean QTc of all patients within 24 h decreased to some extent; (2) the maximum HR decreased slightly from (103 ± 17) times / min to (96 ± 15) times / min preoperatively , While the minimum heart rate increased slightly from (42 ± 7) times / min to (46 ± 5) times / min. (3) The preoperative exercise test caused a significant change in the T wave shape on some leads, These changes disappear or alleviate; (4) The maximum heart rate that can be achieved during postoperative exercise test significantly decreased from (162 ± 4) times / min to (129 ± 10) times / min before surgery (P = 0. 006, n = 4). (5) Five patients were followed up for 15 months. Only 1 patient had 2 episodes of syncope during early morning sleep. The propranolol dose was only 20 mg .3 mg / kg) once daily. The remaining patients were asymptomatic, taking the medication as follows: 2 cases were not taking medicine in the recent 1 year, 1 case of 20 mg twice daily and 1 case of 10 mg 3 times daily. Conclusion LCSD is a safe and effective therapy for patients with LQTS that can not be controlled by drugs. The cost of the LCSD is relatively low compared to the cost of the ICD and the surgical procedure is simple and therefore may be of great importance to LQTS patients in developing countries like China.