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目的:总结女性肥厚型梗阻性心肌病(HOCM)行经皮室间隔心肌化学消融术(PTSMA)治疗的疗效及安全性。方法:入选2000-01-2015-04实施PTSMA治疗的女性患者的临床资料和化学消融结果,总结绝经后女性和未绝经女性HOCM患者行PTSMA的术中、术后围术期并发症的发生情况及住院期间临床疗效,探讨女性HOCM患者行PTSMA的疗效及安全性。结果:107例女性HOCM患者中共106例接受PTSMA治疗,术后比术前静息及期前收缩后左心室流出道压力阶差明显下降[(17.76±22.42)mmHg∶(74.28±38.03)mmHg,P=0.000;(38.70±21.04)mmHg∶(117.48±39.75)mmHg,P=0.000],差异均有统计学意义。绝经后女性共72例,其中71例接受PTSMA治疗,术后比术前静息及期前收缩后左心室流出道压力阶差明显下降[(17.19±20.38)mmHg∶(75.49±37.51)mmHg,P=0.000;(40.44±23.27)mmHg∶(120.98±37.28)mmHg,P=0.000],差异均有统计学意义。未绝经女性共35例,术后比术前静息及期前收缩后左心室流出道压力阶差亦明显下降[(18.97±26.64)mmHg∶(71.65±39.63)mmHg,P=0.000;(33.74±11.92)mmHg∶(107.21±43.03)mmHg,P=0.000],差异均有统计学意义。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变化[△(58.37±30.36)mmHg∶△(52.68±27.06)mmHg,P=0.374;△(83.21±32.07)mmHg∶△(74.00±38.70)mmHg,P=0.313],两组无水酒精用量无统计学差异[(1.83±0.70)ml∶(1.89±0.74)ml,P=0.697]。术中及术后绝经后女性较严重并发症发生率明显高于未绝经女性(23.61%∶5.71%,P=0.035),但Logistic回归分析显示,是否绝经并非较严重并发症的独立危险因素。结论:女性HOCM患者无论是否绝经行PTSMA治疗均是有效的。绝经的患者较严重并发症发生率较高,但绝经并非独立的危险因素。
Objective: To summarize the efficacy and safety of percutaneous transluminal myocardial chemical ablation (PTSMA) in hypertrophic obstructive cardiomyopathy (HOCM). Methods: The clinical data and chemical ablation results of female patients receiving PTSMA from 2000-01-2015-04 were enrolled. The postoperative perioperative complications of PTSMA in postmenopausal women and non-menopausal women with HOCM were summarized And clinical efficacy during hospitalization, to investigate the efficacy and safety of PTSMA in female HOCM patients. Results: A total of 106 patients with HOCM were treated with PTSMA. The difference in postoperative left ventricular outflow tract pressure was significantly lower than that of preoperative and premature contractions [(17.76 ± 22.42) mmHg: (74.28 ± 38.03) mmHg, P = 0.000; (38.70 ± 21.04) mmHg: (117.48 ± 39.75) mmHg, P = 0.000], the differences were statistically significant. There were 72 postmenopausal women, of whom 71 received PTSMA. The postoperative differences in postoperative left ventricular outflow tract pressure were significantly decreased ([(17.19 ± 20.38) mmHg:(75.49 ± 37.51) mmHg, P = 0.000; (40.44 ± 23.27) mmHg: (120.98 ± 37.28) mmHg, P = 0.000], the differences were statistically significant. There were 35 cases of non-menopausal women, the pressure difference of left ventricular outflow tract after operation was significantly lower than that of preoperative and premature contractions [(18.97 ± 26.64) mmHg: (71.65 ± 39.63) mmHg, P = 0.000; (33.74 ± 11.92) mmHg: (107.21 ± 43.03) mmHg, P = 0.000], the differences were statistically significant. There was no significant change in pressure gradient between left and right ventricular outflow tract before and after preoperative and postoperative premature and postoperative premature and postoperative premature beat [△ (58.37 ± 30.36) mmHg:Δ (52.68 ± 27.06) mmHg, P = 0.374; △ 83.21 ± 32.07 mmHg : (74.00 ± 38.70) mmHg, P = 0.313]. There was no significant difference in the amount of anhydrous alcohol between the two groups (1.83 ± 0.70 ml: 1.89 ± 0.74 ml, P = 0.697). The postoperative menopausal women postoperatively more serious complications were significantly higher than those in non-menopausal women (23.61%: 5.71%, P = 0.035), but Logistic regression analysis showed that whether menopause is not an independent risk factor for more serious complications. CONCLUSIONS: Female HOCM patients are effective regardless of PTSMA treatment. Menopausal patients with a higher incidence of more serious complications, but not an independent risk factor for menopause.