增强型体外反搏的临床应用：常见问题及其对策

增强型体外反搏治疗分别在2002年与2006年先后进入了美国心脏病学会、欧洲心脏病学会及中华医学会关于稳定型心绞痛的治疗指南。随着体外反搏疗法在心绞痛患者治疗中的应用日益普及,在临床应用中出现了与患者相关和/或与治疗相关的一些问题,现就这些体外反搏临床实践中常见问题和相应对策进行探讨。本文将着重考虑有以下一种或多种特征的患者人群：老年、糖尿病、肥胖或低体重、心力衰竭,外周血管疾病和接受抗凝治疗的患者。此外,还对治疗中舒张期增压不理想、心房颤动和起搏器患者的同步化问题,体外反搏的时机和疗程等治疗建议进行了回顾。大量临床研究已证实特定患者能从体外反搏治疗中获益,本文则尝试就这些特定患者接受体外反搏治疗中遇到的不同问题提出应用建议。

Clinical Practice of Enhanced External Counterpulsation: Problems and Solutions

Enhanced external counterpulsation （EECP） therapy has been recommended for the treatment of patients with chronic sta- ble angina by American College of Cardiology / American Heart Association, European Society of Cardiology and Chinese Medical Associa- tion in 2002, 2006 and 2006, respectively. As the application of EECP therapy for angina patients broadens in clinical practice, problems a- rose with regard to specific patient subgroups and EECP treatment itself. In this review, we addressed each of these relevant problems with attempts to provide practice guidelines of management for them. The practice of EECP in the following patient subgroups will be reviewed： the elderly, the diabetics, those who are obese or underweight, with heart failure, with peripheral arterial diseases, and those receiving anti- coagulant therapy. In addition, technical problems during the implementation of EECP therapy, including unsatisfactory diastolic augmenta- tion, synchronization in patients with atrial fibrillation and pace-maker implantation, as well as the timing and sessions of EECP, were also examined. Notwithstanding the therapeutic benefit of EECP in selected patients has already been documented by numerous studies, this re- view endeavored to address practical problems associated with the use of EECP for some specific patient subgroups and situations.