Effects of varying alcohol dosing in percutaneous septal ablation for obstructive hypertrophic cardiomyopathy on myocardial infarct size and arrhythmias within peri-interventional period
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摘要: 目的:探讨经皮室间隔心肌化学消融（PTSMA）酒精用量与围术期心肌损伤和心律失常发生的关系。方法:连续选择接受低剂量酒精（≤2ml）消融的肥厚型梗阻性心肌病（HOCM）患者10例（低剂量组）,从资料库中筛选常规较大剂量酒精（＞2ml）治疗的患者20例作为对照组,分别记录两组患者围术期血清肌酸激酶同工酶（CK-MB）峰值及心律失常的发生情况,同时评估两种剂量酒精对术后血流动力学和心脏结构的影响。结果:低剂量组和对照组PTSMA围术期CK-MB峰值分别为（126.9±55.3）U/L和（232.8±58.7）U/L（P<0.01）;相关分析显示,CK-MB峰值与酒精剂量呈显著正相关（r=0.646,P<0.01）;两组发生急性房室传导异常（含束支、室内传导和Ⅰ～Ⅲ度房室传导阻滞）分别为6例（60%）和13例（65%）,发生Ⅲ度房室传导阻滞分别为2例（20%）和5例（25%）;两组术后左心室流出道压力阶差（LVOTPG）和室间隔厚度较基线水平均显著下降（均P<0.01）,但两组间术后LVOTPG水平及下降幅度均差异无统计学意义。结论:低剂量酒精能减少PTSMA围术期心肌坏死,并显著改善术后血流动力学和心脏结构,但不能减轻传导系统的损伤。
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关键词:
- 心律失常 /
- 经皮室间隔心肌化学消融 /
- 酒精用量 /
- 心肌损伤
Abstract: Objective:To evaluate the beneficial effects of low-dose alcohol in pecutaneous transluminal septal myocardial ablation（PTSMA） for obstructive hypertrophic cardiomyopathy（HOCM）.Method:A 1:2 matched case-control study was performed in our hospital.10 consecutive patients with HOCM received a small amount of alcohol（≤2 ml）,and they were compared with 20 cases receving standard dose（＞2 ml）.Early results of myocardial infarct size and arrhythmias within perioperative period were determined by peak CK-MB and electrocardiogram.The resultant hemodynamic changes and left ventricular remodeling were also checked.Result:The CK-MB peak within peri-interventional period were（126.9±55.3）U/L and（232.8±58.7）U/L（P<0.01）.There was a significant correlation between peak CK-MB and alcohol dose（r=0.646,P<0.01）.Acute abnormalities in conduction system occurred in 6 patients（60%） from low-dose group and 13 patients（65%） from control group.Temporary post procedural complete atrioventricular block was identified in 2 patients（20%） from low-dose group and 5 patients（25%） from control group.Post-procedural LVOTPG and interventricular septum decreased significantly（P<0.01）.But there was no significant difference in the level of Post-procedural LVOTPG and decreasing amplitude between the 2 groups.Conclusion:Low dose of alcohol minimize the myocardial infarct size,but can not eliminate or lower the occurrence of arrhythmias（mostly atrioventricular abnormalities） during the peri-interventional period. -
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