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目的：观察肥厚梗阻型心肌病（ＨＯＣＭ）患者右室起搏治疗的远期临床、血流动力学及形态学变化，以确定右室起搏对患者的治疗效果及预后。方法：采用有创血流动力学监测技术及超声多普勒检查方法观察右室起搏前、后（２ ｈ、１２周、４年）患者的血流动力学及形态学变化。结果：右室起搏治疗４年后，患者临床症状、心功能、多数血流动力学及形态学指标均有不同程度改善；尤其是左室舒张期末压力（ＬＶＥＤＰ）、左室流出道（ＬＶＯＴ）压力阶差（ＬＶＯＴＧ），ＬＶＯＴ内径、ＬＶＯＴ血流速度、二尖瓣前向运动（ＳＡＭ）评级等均较起搏前显著降低或减少（Ｐ＜０． ０１），其中 ＬＶＯＴＧ，ＬＶＯＴ血流速度及 ＳＡＭ评级又较起搏１２周时显著改善（Ｐ＜０．０５）；心排血量（ＣＯ）及心排血指数（ＣＩ）较起搏治疗前明显增加，肥厚的室间隔较起搏前及起搏１２周时均明显变薄（Ｐ＜０．０５）。结论：右室起搏能显著地改善患者的临床症状、心功能及血流动力学指标，并能逆转肥厚的室间隔及左室游离壁，改善ＬＶＯＴ梗阻，其远期疗效显著；对药物治疗无效或疗效不满意的ＨＯＣＭ患者起搏治疗可能成为较为理想的治疗措施。
Objective: To observe the long-term clinical, hemodynamic and morphological changes of right ventricular pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM) to determine the effect and prognosis of right ventricular pacing in patients. Methods: The hemodynamic and morphological changes in patients before and after right ventricular pacing (2 h, 12 weeks, 4 years) were measured by invasive hemodynamic monitoring and ultrasound Doppler imaging. Results: After 4 years of right ventricular pacing, clinical symptoms, cardiac function, most hemodynamic and morphological parameters were improved to some extent; especially left ventricular end-diastolic pressure (LVEDP), left ventricular outflow tract ) LVOTG, LVOT diameter, LVOT flow velocity, and mitral valve forward motion (SAM) were significantly decreased or decreased compared with that before pacing (P <0.01). LVOTG, LVOT blood flow (P <0.05). The cardiac output (CO) and cardiac output index (CI) were significantly higher than those before pacing, and the ventricular septum of hypertrophy was higher Before the stroke and pacing at 12 weeks were significantly thinner (P <0.05). Conclusion: Right ventricular pacing can significantly improve clinical symptoms, cardiac function and hemodynamic parameters, and can reverse the hypertrophy of the interventricular septum and left ventricular free wall to improve LVOT obstruction, the long-term effect is significant; for drug treatment Inconsistent or curative effect in patients with HOCM pacing may be the ideal treatment.