84例肥厚型心肌病患者的临床特点和治疗分析

目的 分析肥厚型心肌病的临床特点和治疗方法。方法 回顾性分析2008年1月至2013年12月在安徽医科大学第一附属医院就诊的肥厚型心肌病患者的临床资料。结果 84例肥厚型心肌病患者常见的临床症状主要有胸闷气短、心悸、胸痛、呼吸困难、头晕黑曚、前兆晕厥或晕厥。常见的合并疾病有高血压病、冠心病和心律失常,心律失常中最常见的为房颤和各种传导阻滞。95.2%的肥厚型心肌病患者心电图有异常表现,最常见的异常表现为左心室肥厚和(或)ST-T改变。80例患者接受β受体阻滞剂和(或)非二氢吡啶类钙离子拮抗剂治疗,11例患者接受起搏器置入治疗,22例接受经皮室间隔心肌化学消融术(PTSMA),2例患者接受外科心肌切除手术。院内死亡1例,死亡原因为恶性心律失常。余82例患者住院期间患者症状均有缓解。结论 肥厚型心肌病患者临床表现多样,治疗应遵循个体化原则,选择合理的药物或手术方法。

Clinical characteristics and therapies of hypertrophic cardiomyopathy in 84 cases

Objective To summarize the clinical characteristics and therapies of 84 patients with hypertrophic cardiomyopathy (HCM). Methods The clinical data of 84 patients with hypertrophic cardiomyopathy treated in this hospital between January 2008 and December 2013 were retrospectively analyzed. Results Among the 84 patients(male=40,female=44) with hypertrophic cardiomyopathy, 41 cases(48.8%) were obstructive cardiomyopathy patients and 43 cases (51.2%) were without obstructive cardiomyopathy. Common clinical symptoms mainly included chest condition (86.9%), palpitations (53.6%), chest pain (47.6%), dyspnea (35.7%), dizziness and amaurosis (27.38%), and a precursor to syncope or syncope (17.9%). The common complicating diseases were hypertension (n=21,25%), coronary heart disease (n=3,3.6%) and cardiac arrhythmias (n=48,57.1%).The most common type of arrhythmia were atrial fibrillation(31.3%) and all kinds of conduction block(60.2%). ECG of 95.2% of the patients was abnormal and the most common abnormalities was left ventricular hypertrophy and (or) ST-T change (n=76,90.5%). Among the 84 patients, 80 patients were treated with beta blockers and (or) two hydrogen pyridine class calcium ion antagonist therapy, 11 patients with pacemaker placement, 22 patients received percutaneous transluminal septal myocardial ablation(PTSMA), and 2 cases were treated with surgery. In 1 case of death, the cause was malignant arrhythmia. The symptoms of hospital patients were all alleviated. Conclusion The clinical manifestations of hypertrophic cardiomyopathy patients are multiple, and the treatment of it should follow the principle of individuation, then the rational drug or surgical method can be selected.