体外心脏震波治疗冠心病的应用研究

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.

Extracorporeal cardiac shock wave therapy for treatment of coronary artery disease

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.