单纯冠状动脉旁路移植术及联合应用激光心肌血运重建术治疗重症冠心病的研究

目的　探讨激光心肌血运重建术 (TMLR)对重症冠心病患者心肌缺血、心功能影响的机制。方法　冠心病 3支病变重症冠心病住院患者共 6 0例 ,随机分为两组 ,对照组 30例行单纯冠状动脉旁路移植术 (CABG) ,实验组 30例联合应用CABG +TMLR治疗。观察术后 6个月和 12个月时患者心绞痛分级、左心室射血分数 (LVEF)、6分钟步行距离 (6MWD)和血浆脑利钠肽 (BNP)、血管内皮生长因子 (VEGF)浓度的变化。结果　随访 1年 ,两组死亡率差异无显著性意义 ;两组患者的加拿大心脏病协会心绞痛分级、血浆BNP、VEGF水平和 6MWD在随访 6个月均较术前有明显改善 ,但随访 12个月时两组间无显著性差异。结论　在术后半年 ,CABG +TMLR联合治疗重症冠心病患者在降低心绞痛分级、增加运动耐量等方面均优于单纯CABG ,但术后 1年时 ,两种治疗方案的疗效相近。

The investigation of coronary artery bypass grafting combined with or without transmyocardial laser revascularization for treatment of end-stage coronary artery diseases

Objective To explore the mechanism of benefical effects of TMLR on myocardial ischemia and left ventricular function in patients with end-stage coronary artery disease. Methods A total of 60 patients with triple lesion of end-stage coronary artery disease were enrolled into this study and were divided randomly into two groups.The control group consisted of 30 patients treated with CABG and the study group consisted of 30 patients treated with combination therapy of CABG and TMLR. The plasma levels of BNP and VEGF were measured before and after operation,as well as at 6 months and 12 months of the follow-up. The changes of indexes of 6MWD and LVEF were observed simultaneously.Results There was no significant difference in mortality between the two groups. All patients of the two groups after surgery were examined at 6 months and 12 months of follow-up.There was significant improvement of CCS angina classes,6MWD and the plasma levels of BNP and VEGF at 6 months in both groups and 6MWD and CCS angina classes were improved more significantly.in the study group However, the difference became not significant at 12 months after operation.Conclusion The combination therapy of CABG with TMLR is likely more effective in improving the angina pectoris class and 6MWD at 6 months after operation than CABG alone. However, the efficacy of these two protocols was similar 12 months after operation.