经皮激光心肌血运重建术治疗严重冠心病患者的疗效和随访结果  

Effects and follow-up results of percutanous transluminal laser myocardial revascularization for treatment of serious coronary disease

作　　者：何国祥[1] 宋治远[1] 迟路湘[1] 唐波[1,2] 胡厚源[1] 舒茂琴[1] 刘建平[1] 史光鉴[1] 文玲[1] 涂爱华[1] 

机构地区：[1]第三军医大学西南医院心血管内科重庆市介入心脏病学研究所,重庆400038 [2]杭州市第一人民医院,310000

出　　处：《重庆医学》2008年第23期2635-2637,2640,共4页Chongqing medicine

摘　　要：目的报告和分析经皮激光心肌血运重建术(PMR)治疗严重冠心病患者的疗效和随访结果。方法采用EclipseTMR 2000DP钬激光系统行PMR,激光输出能量4J、功率3.5W、波长2.1uM、脉宽200uS。结果34例PMR操作全部完成,平均每例打孔22±6个,术后,加拿大心脏协会(CCS)心绞痛级别由术前3.2±0.4减轻至0.5±0.6(P<0.01),心绞痛减轻大于或等于Ⅱ级或消失的病例占85.3%,LVEF(n=22)由治疗前0.45±0.12增加至0.57±0.13(P<0.01);多数患者心电图缺血型ST-T改变有程度不同的改善;ECT(n=13)示缺血改善者8例。平均随访(48±9)个月,平均CCS心绞痛级别为0.7±0.8,较术前改善大于或等于Ⅱ级者仍占79.4%。并发症包括:术中激光脉冲发放时均有室性期前收缩;急性心包填塞3例,其中1例经抢救后死于心源性休克。结论对反复发作心绞痛的严重冠心病患者,PMR是一种安全和有效的治疗选择,能够显著改善临床症状和心肌缺血。Objective To report the effects and follow-up results of percutanous transluminal laser myocardial revascularization （PMR） for the treatment of serious coronary disease. Methods PMR procedure was finished by Eclipse TMR 2000DP holmium YAG system. Laser energy,wavelength and pulse wide were 4.0J,2. 1uM and 200uS respectively. Results The PMR procedures were successfully completed in all the patients. Average amount of laser channels was 22 ± 6 for each case. After PMR, the clinical conditions significantly improved,including Canada Cardiac Society （CCS） angina pectoris class reduction from 3.2±0.4 to 0.5±0. 6（P〈0. 01） ,the CCS class decrease ≥Ⅱ class and angina pectoris disappeare in 29 of 34 caseas （85.3%）. At follow-up for （48 ±9） months,average CCS class was 0.7±0.8 and the class decreased at ≥Ⅱ class in 27 of these 34 cases（79.4%）. LVEF（22 cases） was increased significantly （0.45±0.12 to 0.57±0.13,P〈 0.01） ,ischemic ST-T change of ECG and myocardial perfusion state detected by ECT（13 cases） were improved. Premature ventricular contractions were observed at project laser in all the patients. Pericardial tamponade occured in 3 cases,one of these 3 patients was death due to cardiac shock. Conclusion PMR is a safe and effective therapeutic option in the patients with refractory angina pectoris and serious coronary lesion. It significantly improves myocardial ischemia and clinical symptoms.

关 键 词：冠心病 治疗 经皮激光心肌血运重建 疗效 随访 

分 类 号：R541.4[医药卫生—心血管疾病] R814.43[医药卫生—内科学]