肥厚型梗阻性心肌病患者运动心肺功能的变化

目的通过检测肥厚型梗阻性心肌病（HOCM）患者的运动功能状态,探讨HOCM患者运动受限机制,并对经皮经腔间隔心肌消融术（PTSMA）的治疗效果进行客观评价。方法选85例HOCM患者做心肺运动功能试验,测最大摄氧量、最大运动负荷、氧脉搏占预计值百分比、无氧阈占预计最大摄氧量百分比及通气当量。从85例HOCM患者中选20例行PTSMA治疗的患者,行PTSMA术前及术后1～3个月、6～12个月重复进行心肺运动功能试验,测量上述指标。结果85例患者均顺利完成了运动试验,无严重并发症发生。无论NYHA心功能分级如何,患者最大摄氧量、最大运动负荷、氧脉搏占预计值百分比,无氧阈占预计最大摄氧量百分比均明显低于健康对照组,通气当量高于健康对照组。其中20例行PTSMA治疗的患者,在治疗后1～3个月复测心肺运动功能试验,运动时间明显延长,心肺运动功能试验各项指标均较治疗前有所增加,6～12个月后再次行心肺运动功能试验,各项指标未进一步改善。结论HOCM患者存在对运动的异常反应,普遍存在运动受限。PTSMA是对药物治疗效果不佳的HOCM患者有效的治疗手段,其远期效果有待进一步观察。

Cardiopulmonary responses to exercise in patients with hypertrophic obstructive cardiomyopathy

OBJECTIVE: The aim of this study was to observe the cardiopulmonary responses to exercise in patients with hypertrophic obstructive cardiomyopathy (HOCM) and to evaluate the effectiveness of percutaneous transluminal septal myocardial ablation (PTSMA). METHODS: Eighty-five patients with HOCM received cardiopulmonary exercise test using a cycle ergometer. Twenty sedentary volunteers served as controls. All patients underwent maximal cardiopulmonary exercise test without severe complication. Among them 20 patients received PTSMA, and the cardiopulmonary exercise test was repeated 1 - 3 months and 6 - 12 months after the intervention. RESULTS: The peak oxygen uptake attained on the test, maximum oxygen pulse and anaerobic threshold were reduced in patients with HOCM compared with the control group (P < 0.01). Patients in New York Heart Association class I had higher cardiopulmonary indexes than those in classes II and III. For those with PTSMA there was a significant increase in peak oxygen uptake, maximum oxygen pulse and anaerobic threshold 1 - 3 months after PTSMA (P < 0.05), but there was no further change after 6 - 12 months. CONCLUSION: The results show that cardiopulmonary exercise testing for patients with HOCM is safe. There are severe abnormalities in exercise responses during incremental upright exercise in HOCM patients. PTSMA is a promising nonsurgical procedure for subjective exercise limitation in patients with HOCM. Long-term observations for the patients with this procedure are necessary.