CAJ | 학술논문

目的初步评价体外心脏冲击波治疗(CSwT)在难治性心绞痛治疗中的临床疗效和安全性.方法诊断明确的难治性心绞痛患者28例,男22例,女6例,平均年龄为(68.2±12.0)岁,接受CSWT,指定治疗仪(100击/点,能量为0.09 mJ/mm~2,每次3～6点,3次/周),3次治疗为1组,间隔3周进行1组治疗,共治疗9周.观察治疗前后加拿大心绞痛分级(CCS分级)、西雅图心绞痛量表(SAQ积分)、核素心肌血流灌注情况、左心室射血分数(LVEF)变化、6 min步行距离、心电图、血和尿常规以及心肌损伤标志物等.结果人组患者中有27例完成治疗,17例完成治疗后6个月随访.治疗后6个月,患者的CCS分级为(2.0±0.0)级,显著低于治疗前的(2.5±0.5)级(P<0.01),纽约心脏病学会(NYHA)心功能分级为(1.8±0.6)级,显著低于治疗前的(2.0±0.7)级(P=0.03).~(99m)Tc-核素心肌显像显示,治疗6个月后的心肌区域血液灌流明显增加,缺血节段减少(P值均<0.05).治疗6个月后的左心室舒张末容积为(157.67±91.38)mL,低于治疗前的(172.11±102.01)mL;左心室收缩末容积为(99.44±86.44)mL,低于治疗前的(114.56±99.37)mL(P>0.05);LVEF为0.459±0.205,高于治疗前的0.422±0.188;但差异均无统计学意义(P值均>0.05).所有患者在治疗中及治疗后均无心律失常、心绞痛发作等不适症状,也无心肌损伤标志物升高.结论对于晚期冠状动脉性心脏病、弥漫性血管病变以及不适用传统心肌再血管化治疗的患者,CSWT是一种安全、可行的选择.
목적 초보평개체외심장충격파치료(CSwT)재난치성심교통치료중적림상료효화안전성.방법 진단명학적난치성심교통환자28례,남22례,녀6례,평균년령위(68.2±12.0)세,접수CSWT,지정치료의(100격/점,능량위0.09 mJ/mm~2,매차3～6점,3차/주),3차치료위1조,간격3주진행1조치료,공치료9주.관찰치료전후가나대심교통분급(CCS분급)、서아도심교통량표(SAQ적분)、핵소심기혈류관주정황、좌심실사혈분수(LVEF)변화、6 min보행거리、심전도、혈화뇨상규이급심기손상표지물등.결과 인조환자중유27례완성치료,17례완성치료후6개월수방.치료후6개월,환자적CCS분급위(2.0±0.0)급,현저저우치료전적(2.5±0.5)급(P<0.01),뉴약심장병학회(NYHA)심공능분급위(1.8±0.6)급,현저저우치료전적(2.0±0.7)급(P=0.03).~(99m)Tc-핵소심기현상현시,치료6개월후적심기구역혈액관류명현증가,결혈절단감소(P치균<0.05).치료6개월후적좌심실서장말용적위(157.67±91.38)mL,저우치료전적(172.11±102.01)mL;좌심실수축말용적위(99.44±86.44)mL,저우치료전적(114.56±99.37)mL(P>0.05);LVEF위0.459±0.205,고우치료전적0.422±0.188;단차이균무통계학의의(P치균>0.05).소유환자재치료중급치료후균무심률실상、심교통발작등불괄증상,야무심기손상표지물승고.결론 대우만기관상동맥성심장병、미만성혈관병변이급불괄용전통심기재혈관화치료적환자,CSWT시일충안전、가행적선택.
Objective To evaluate the efficacy and safety of extracorporeal cardiac shock wave therapy (CSVVT) in treatment of patients with refractory coronary artery disease (RCAD) . Methods A total of 28 cases/times of confirmed RCAD patients (22 males and 6 females, mean age of [68.2 ± 12.0] years) received CSWT (100 shots/spot at 0.09 mJ/mm~2 for 3-6 spots, 3 times a week/series) ; the treatment was given every 3 weeks for 9 weeks. The Canadian Cardiovascular Society functional class score (CCS), Seattle angina questionnaire score (SAQ), myocardial perfusion imaging (MPI), left ventricular ejection fraction (LVEF), 6-minute walking test, echocardiogram, blood routine, urine routine and myocardial injury markers were all observed before and after treatment. Result s Twenty-seven patients completed the treatment, and 17 were followed up for 6 months. The CCS class and New York Heart Association (NYHA) class before CSWT and 6 months after treatment showed that CCS class decreased from 2.5 ± 0.5 to 2.0 ± 0.0 (P<0.01) and NYHA class decreased from 2.0 ± 0.7 to 1.8±0.6 (P =0.03). Single-photon emission computed tomograph (SPECT) myocardial perfusion imaging revealed an increase in perfusion in treated myocardial segments and decrease in untreated segments. In addition, it demonstrated that after 6 months treatment the left ventricular end-diastolic volume (LVEDV) decreased from (172.11 ± 102.01) mL to (157.67 ± 91.38) mL (P> 0.05), left ventricular end-systolic volume (LVESV) decreased from (114.56 ± 99.37) mL to (99.44 ± 86.44) mL (P >0.05), and LVEF increased from 0. 422 ± 0. 188 to 0. 459±0. 205(P>0.05). No cardiac arrhythmia or angina pectoris was noticed during treatment. Conclusion CSWT is a safe and feasible choice for patients with end-stage coronary artery disease, diffuse vascular lesions, and those who are not suitable for traditional myocardial revascularization treatment.