体外心脏震波治疗冠心病的应用研究
체외심장진파치료관심병적응용연구
Extracorporeal cardiac shock wave therapy for treatment of coronary artery disease
  • 万方数据
    中华心血管病杂志 중화심혈관병잡지
    Chinese Journal of Cardiology
    2010年 8期 711-715 ,共5页

    王钰%郭涛%蔡红雁%马铁昆%陶四明%陈明清%顾云%潘家华%肖践明%赵玲%杨西云%羊超

    왕옥%곽도%채홍안%마철곤%도사명%진명청%고운%반가화%초천명%조령%양서운%양초

    心肌梗死%心绞痛,不稳定型%新生血管化,生理性%体外心脏震波 心肌梗死%心絞痛,不穩定型%新生血管化,生理性%體外心髒震波
    심기경사%심교통,불은정형%신생혈관화,생이성%체외심장진파
    Myocardial infarction%Angina,unstable%Neovascularization,physiologic%Extracorporeal cardiac shock wave therapy
    目的 探讨体外心脏震波治疗冠心病的安全性、有效性和基本方法学要点.方法 纳入35例冠心病陈旧性心肌梗死及不稳定性心绞痛患者,其中25例应用瑞士Storz Medical公司生产的震波治疗仪,进行体外心脏震波治疗,10例作为阳性对照.治疗前经小剂量多巴酚丁胺负荷超声心动图和99Tcm-甲氧基异丁基异腈心肌灌注显像(MPI)识别存活心肌,定位缺血节段.治疗组分为2个亚组,A组(16例,29个节段)采用3个月完成9次治疗,第4个月随访;B组(9例,13个节段)采用1个月完成9次治疗,第2个月随访.治疗时经机载实时超声探头锁定缺血靶区,每个靶区实施-1～0～+1两两组合的9点治疗,每点发放200次脉冲,每次脉冲能量为0.09 mJ/mm2.整个过程行实时心电、血压、血氧饱和度监测.随访采用纽约心功能分级(NYHA)、加拿大心血管学会(CCS)心绞痛分级、西雅图心绞痛量表(SAQ)、6 min步行距离(6MWT)和硝酸甘油用量行临床评估,采用收缩期峰值应变率(PSSR)和MPI评价局部心肌收缩功能和血流灌注.结果 25例患者共42个缺血节段接受了9次震波治疗,血液动力学稳定,未出现心肌损伤、出血、栓塞等并发症;与治疗前比较,治疗后的NYHA、CCS心绞痛分级和硝酸甘油用量较少(P＜0.01),SAQ评分、6MWT较高(P＜0.05).治疗组治疗区域的静息态MPI评分和负荷态PSSR明显增高(P＜0.01).A组负荷态MPI评分治疗后高于治疗前(1.21±0.86比0.83±0.80,P＜0.01),缺血改善程度优于B组.对照组以上指标改变甚微.结论 初步研究表明,体外心脏震波治疗是一项无创、安全、有效的新型血管再生疗法,可以缓解患者心绞痛,提高运动耐量.
    목적 탐토체외심장진파치료관심병적안전성、유효성화기본방법학요점.방법 납입35례관심병진구성심기경사급불은정성심교통환자,기중25례응용서사Storz Medical공사생산적진파치료의,진행체외심장진파치료,10례작위양성대조.치료전경소제량다파분정알부하초성심동도화99Tcm-갑양기이정기이정심기관주현상(MPI)식별존활심기,정위결혈절단.치료조분위2개아조,A조(16례,29개절단)채용3개월완성9차치료,제4개월수방;B조(9례,13개절단)채용1개월완성9차치료,제2개월수방.치료시경궤재실시초성탐두쇄정결혈파구,매개파구실시-1～0～+1량량조합적9점치료,매점발방200차맥충,매차맥충능량위0.09 mJ/mm2.정개과정행실시심전、혈압、혈양포화도감측.수방채용뉴약심공능분급(NYHA)、가나대심혈관학회(CCS)심교통분급、서아도심교통량표(SAQ)、6 min보행거리(6MWT)화초산감유용량행림상평고,채용수축기봉치응변솔(PSSR)화MPI평개국부심기수축공능화혈류관주.결과 25례환자공42개결혈절단접수료9차진파치료,혈액동역학은정,미출현심기손상、출혈、전새등병발증;여치료전비교,치료후적NYHA、CCS심교통분급화초산감유용량교소(P＜0.01),SAQ평분、6MWT교고(P＜0.05).치료조치료구역적정식태MPI평분화부하태PSSR명현증고(P＜0.01).A조부하태MPI평분치료후고우치료전(1.21±0.86비0.83±0.80,P＜0.01),결혈개선정도우우B조.대조조이상지표개변심미.결론 초보연구표명,체외심장진파치료시일항무창、안전、유효적신형혈관재생요법,가이완해환자심교통,제고운동내량.
    Objective To evaluate the feasibility and efficiency of extracorporeal cardiac shock wave therapy(CSWT)for treatment of coronary artery disease. Methods Twenty-five patients with 1-16 years history of chronic angina pectoris underwent the CSWT. Before and after the treatment, low -dose Dobutamine stress echocardiography and 99Tcm-MIBI myocardial perfusion SPECT were applied to locate the ischemic segments, detect the viable myocardium and evaluate the effect of CSWT. Under the guidance of echocardiography, CSWT was applied in R-wave-triggered manner with low energy(0. 09 mJ/mm2)at 200 shoots/spot for9 spots(-1 -0- + 1 combination). Patients were divided group A and group B. Sixteen patients in group A were applied 9 sessions on 29 segments within 3 month and nine patients in group B were applied 9 sessions on 13 segments within 1 month. Ten chronic angina pectoris patients receiving standard medication served as controls. Results All patients completed the 9 sessions without procedural complications or adverse effects. CSWT significantly improved symptoms as evaluated by NYHA, Canadian Cardiovascular Society(CCS)class sores, Seattle angina questionnaire(SAQ), 6-min walk and the use of nitroglycerin(P＜0. 05). CSWT also improved myocardial perfusion and regional myocardium function as evaluated by rest SPECT and stress peak systolic strain rate(PSSR)(P ＜ 0. 01). Myocardial perfusion improvement was more significant in group A compared with group B(1.21 ± 0. 86 vs. 0. 83 ± 0. 80, P ＜0. 01). All parameters remained unchanged in control group during follow up. Conclusion These preliminary results indicate that CSWT is safe and effective on ameliorating anginal symptoms for chronic angina pectoris patients.
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