体外反搏在冠心病治疗中的应用及其循证医学证据

体外反搏的原理是在心脏的舒张期反肢体血液驱回心脏,增加心脏舒张期灌注,改善心肌缺血。迄今为止,在美国和我国已相继开展了多个与体外反搏有关的、观察体外反搏治疗冠心病和心功能不全效果和安全性的大型临床试验（MUST-EECP、RECC、PEECH和IEPR）,取得了很多具有重要科研价值的学术资料。2002年美国ACC/AHA正式将体外反搏疗法纳入冠心病心绞痛的临床治疗指南。体外反搏适应于急性冠状动脉综合征、心源性休克、稳定型心绞痛和稳定性心力衰竭的患者。绝对禁忌证不多,主要包括中至重度的主动脉瓣关闭不全、需要手术的腹主动脉瘤、最近发生的静脉血栓形成、严重肺动脉高压、收缩压控制不佳及显著的出血倾向者。

Enhanced External Counterpulsation for Treatment of Coronary Artery Disease:Practice and Evidence

The basic working principle of enhanced external counterpulsation （EECP） is the generation of a strong retrograde arterial flow during diastole, thereby increasing coronary perfusion and improving myocardial ischemia. Up till now, several major clinic trials such as MUST-EECP, RECC, PEECH and IEPR have been conducted in China and America,and the safety and efficacy of EECP treatment in patients with coronary heart disease were addressed. Clinical experiences as well as research results have been accumulated in abundance from these trials. EECP is recommended in the 2002 ACC/AHA guideline for the treatment of patients with coronary heart disease. EECP is also indica- ted for some selected patients with acute coronary syndrome, cardiac shock, and stable congestive heart failure. Conversely, EECP has few ab- solute contraindications, which may include hemodynamics-compromising aortic valve regurgitation, abdominal aortic aneurysm requiring inter- vention,recent history of venous thromboembolism, severe pulmonary hypertension,poorly-controlled systolic hypertension and patients with trends of major bleeding.