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目的:探讨经皮室间隔心肌化学消融术(PTSMA)最适酒精使用剂量。方法:连续选择2007年1月～2010年12月在本院接受低剂量酒精(≤2.0 ml)消融的肥厚梗阻型心肌病(HOCM)患者10例;按1∶2配比的病例对照研究,选择2000年1月～2006年12月接受较大剂量酒精(>2.0 ml)消融治疗的患者20例作为历史对照组,分别评估两种治疗方案对术后早期血流动力学和心脏重构的影响。结果:低剂量和对照组术后即刻[(28.0±8.8)mmHg和(27.5±7.2)mmHg]、术后3个月[(29.5±6.6)mmHg和(28.1±5.0)mmHg]的左心室流出道压力阶差(LVOTPG)均较基线时[(69.9±13.1)mmHg和(70.6±13.4)mmHg]显著性下降(P<0.01),术后室间隔厚度明显减小(P<0.01),左心室舒张末内径无变化;而两组间术后即刻、术后3个月LVOTPG水平及下降幅度均无差异(P>0.05);相关分析显示,酒精用量分别与术后即刻LVOTPG以及术后3个月LVOTPG、室间隔厚度和左室舒张末内径等变化无相关性(P>0.05)。结论:小剂量酒精消融同样导致术后早期血流动力学和心脏结构的改善。
Objective: To study the optimal dosage of alcohol for percutaneous transcatheter closure myocardial chemical ablation (PTSMA). Methods: Ten consecutive patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent low-dose alcohol (≤2.0 ml) ablation in our hospital from January 2007 to December 2010 were selected. A case- Twenty patients who underwent ablation of larger dose of alcohol (> 2.0 ml) from January 2000 to December 2006 were selected as the historical control group, and the effects of the two treatment regimens on the postoperative early hemodynamics and cardiac remodeling influences. RESULTS: Left ventricular outflows in the low dose group and those in the control group were (28.0 ± 8.8) mmHg and (27.5 ± 7.2) mmHg postoperatively, respectively, and were (29.5 ± 6.6) mmHg and (28.1 ± 5.0) mmHg after 3 months LVOTPG decreased significantly compared with baseline (69.9 ± 13.1 mmHg and 70.6 ± 13.4 mmHg respectively) (P <0.01), and postoperative ventricular septal thickness decreased significantly (P <0.01) There was no significant difference in LVOTPG level and decrease range between the two groups immediately after operation and 3 months after operation (P> 0.05). Correlation analysis showed that alcohol consumption was significantly correlated with LVOTPG and postoperative 3 Month LVOTPG, ventricular septal thickness and left ventricular end diastolic diameter and other changes have no correlation (P> 0.05). Conclusions: Low dose alcohol ablation also leads to early postoperative hemodynamic and cardiac structural improvements.