梗阻性肥厚型心肌病患者左心室流出道疏通术后1年心电图及心脏超声的特点

doi:10.16138/j.1673-6087.2025.02.09

摘要/Abstract

摘要：

目的：探讨梗阻性肥厚型心肌病患者行左心室流出道疏通术后1年心电图及心脏超声相关变化及特点。方法：入选2018年1月1日至12月31日期间在上海交通大学医学院附属瑞金医院明确诊断为梗阻性肥厚型心肌病并接受左心室流出道疏通术的患者共38例，收集临床资料及术前、术后1年的心电图和心脏超声结果，进行对比分析，总结其相关变化及特点。结果：手术后1年随访心电图诊断为左心室肥厚的比例较手术前显著下降（52.6%比12.9%，P<0.01），诊断为完全性左束支传导阻滞比例显著上升（2.6%比58.1%，P<0.01）。术后1年随访心脏超声显示患者左室射血分数较术前降低（68.50%±4.11%比63.87%±4.00%，P<0.01）。术后1年有完全性左束支传导阻滞患者左室射血分数较术前降低（69.39%±5.29%比63.40%±4.15%，P<0.01），无完全性左束支传导阻滞患者左室射血分数手术前后无统计学差异（67.46%±2.96%比64.83%±4.20%，P=0.082）。结论：左心室流出道疏通术可有效降低梗阻性肥厚性心肌病患者的左心室肥厚比例，缓解流出道梗阻，但术后有完全性左束支阻滞的患者左室射血分数有降低趋势。

关键词: 梗阻性肥厚型心肌病, 左心室流出道疏通术, 心电图, 左心室肥厚, 完全性左束支传导阻滞, 左室射血分数

Abstract:

Objective To investigate the changes and characteristics of electrocardiogram and echocardiography in patients with hypertrophic obstructive cardiomyopathy at 1 year after left ventricular outflow tract dredging.Methods To investigate patients diagnosed with hypertrophic obstructive cardiomyopathy who underwent left ventricular outflow tract dredging surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1 to December 31 in 2018. A total of 38 cases were enrolled, the clinical features, electrocardiogram and echocardiography data before, 1 year after surgery were collected for comparative analysis and summarizations.Results There were significant statistical differences in the proportion of left ventricular hypertrophy (LVH) and complete left bundle branch block (CLBBB) on electrocardiogram (52.6% vs 12.9%, P<0.01) and (2.6% vs 58.1%, P<0.01), respectively. Echocardiography showed a significant reduction in left ventricular ejection fraction (LVEF) (68.50%±4.11% vs 63.87%±4.00%, P<0.01). In post-surgery patients with CLBBB (67.46%±2.96% vs 64.83%±4.20%, P=0.082), there was a significant reduction in LVEF (69.39%±5.29% vs 63.40%±4.15%, P<0.01), while there was no statistical difference in patients without CLBBB.Conclusions Left ventricular outflow tract dredging surgery could effectively reduce the proportion of LVH in patients with hypertrophic obstructive cardiomyopathy and alleviate outflow tract obstruction. However, patients who developed CLBBB after surgery showed a tendency of reduced LVEF.

Key words: Hypertrophic obstructive cardiomyopathy, Left ventricular outflow tract dredging, Electrocardiogram, Left ventricular hypertrophy, Complete left bundle branch block, Left ventricular ejection fraction

中图分类号:

R541

王鸿珍, 刘霞. 梗阻性肥厚型心肌病患者左心室流出道疏通术后1年心电图及心脏超声的特点[J]. 内科理论与实践, 2025, 20(02): 152-156.

WANG Hongzhen, LIU Xia. Electrocardiographic and echocardiographic characteristics of patients with hypertrophic obstructive cardiomyopathy at one year after left ventricular outflow tract dredging[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(02): 152-156.

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参考文献 10

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项目	术前	术后1年随访	t	P
心室率（次/min）	64.97±15.62	73.87±11.77	2.517	0.014
PR间期（ms）	157.33±23.31	167.61±25.50	1.723	0.090
QRS间期（ms）	99.22±12.01	138.97±23.23	8.588	0.000
QT间期（ms）	407.58±34.60	415.74±37.82	0.922	0.302
QTc间期（ms）	425.39±33.48	455.16±31.86	3.711	0.000
V5 R波振幅（mV）	2.42±1.14	1.27±0.81	-4.707	0.000
V1 S波振幅（mV）	1.99±0.76	2.45±0.82	2.377	0.020

项目	术前	术后1年随访	t	P
AO（mm）	32.84±3.02	32.93±3.38	0.117	0.907
LAD（mm）	45.87±5.08	42.07±4.79	-2.611	0.037
LVEDd（mm）	45.87±5.08	47.53±4.42	1.42	0.160
LVESd（mm）	28.21±3.53	30.40±4.05	2.379	0.020
IVSd（mm）	18.37±3.66	11.70±2.67	-8.37	0.000
LVPWT(mm)	11.10±1.54	9.90±1.12	-3.596	0.001
LVEDV（mL）	96.92±31.27	107.43±23.76	1.525	0.132
LVESV（mL）	31.47±9.90	38.73±10.60	2.911	0.005
LVEF（%）	68.50±4.11	63.87±4.00	-4.666	0.000
LVFS（%）	37.95±4.23	34.67±3.05	-3.547	0.001
SV（mL）	68.08±18.25	68.47±15.38	0.093	0.926

项目	术前	术后1年随访	t	P
AO（mm）	32.83±3.36	32.80±3.32	0.029	0.977
LAD(mm)	43.89±4.08	42.47±4.67	0.933	0.358
LVEDd(mm)	44.83±5.60	49.20±4.84	-2.37	0.024
LVESd(mm)	27.39±3.68	32.13±3.64	-3.705	0.001
IVSd(mm)	18.44±3.29	11.33±2.22	7.109	0.000
LVPWT(mm)	10.94±1.55	9.47±1.06	3.126	0.004
LVEDV(mL)	89.06±36.91	116.80±26.45	-2.434	0.021
LVESV(mL)	29.22±10.24	42.47±11.49	-3.501	0.001
LVEF(%)	69.39±5.29	63.40±4.15	3.595	0.001
LVFS(%)	38.06±5.84	34.40±3.14	2.172	0.038
SV(mL)	65.44±21.20	74.07±17.49	-1.257	0.218

项目	术前	术后1年随访	t	P
AO（mm）	32.62±2.75	32.83±3.01	-0.189	0.852
LAD(mm)	47.08±6.50	41.67±5.65	2.213	0.037
LVEDd(mm)	45.77±4.22	45.58±3.68	0.117	0.908
LVESd(mm)	28.38±3.30	29.00±3.16	-0.475	0.639
IVSd(mm)	17.38±2.99	11.67±2.31	5.321	0.000
LVPWT(mm)	11.54±1.76	10.25±0.96	2.291	0.034
LVEDV(mL)	98.54±21.61	96.75±18.42	0.222	0.826
LVESV(mL)	32.15±9.36	34.00±9.12	-0.499	0.623
LVEF(%)	67.46±2.96	64.83±4.20	1.821	0.082
LVFS(%)	37.69±2.25	35.25±3.31	2.175	0.040
SV(mL)	66.38±12.96	62.42±11.82	0.797	0.433

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