激光心肌血运重建术治疗冠心病的临床体会  

Clinical experience of transmyocardial laser revascularization treating coronary artery disease

作　　者：屈正[1] 张兆光[1] 孙衍庆[1] 叶建光[1] 于建波[1] 何梅仙 

机构地区：[1]首都医科大学北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》1999年第5期266-268,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的：总结１９９７ 年７ 月至１９９８ 年１２ 月激光心肌打孔治疗５０ 例冠心病病人的临床经验。资料和方法：５０ 例病人平均年龄（６４ ±８） 岁，７０ 岁以上１５ 例。术前心绞痛（３ ．７ ±０ ．７） 级，４０ ％ 为不稳定心绞痛。有陈旧性心肌梗塞史者３３ 例、高血压病３３ 例、糖尿病１９ 例。冠状动脉（ 冠脉） 搭桥和经皮冠脉内成形术后各４ 例。超声心动图示左室射血分数平均为０ ．５１ ±０ ．１１ 。均经冠状动脉及左室造影、单光子发射计算机断层扫描（２０１ 铊－ ＳＰＥＣＴ） 心肌活性测定、运动试验等多项检查，认为有激光心肌血运重建术（ＴＭＬＲ） 指征。在全麻下经左胸前外侧第５ 肋间隙进胸，显露左心室壁。采用高功率二氧化碳激光打孔器（ 美国ＰＬＣ 公司） ，在食管超声监测下对左室壁缺血区域打孔（２１ ±５） 个。结果：术后早期死亡１ 例，余者均于术后１３ ～２５ 天出院。术后并发急性心梗、心功能不全各１ 例，一过性房颤、频发室性早搏各３例。术后３ 、６ 、１２ 个月心绞痛分别改善为（２ ．１ ±０ ．３） 级、（１ ．７ ±０ ．３） 级和（１ ．７ ±０ ．３） 级（ Ｐ＜ ０ ．０５） ，ＳＰＥＣＴ示１９ 例（７０ ％ ） 随访病人心肌灌注得到不同程度改善。Aim:To review the clinical experience of sole transmyocardial laser revascularization(TMLR) in treatment of coronary heart disease(CHD). Clinical material and methods:Fifty patients with CHD were evaluated by coronary angiography and 201 TI single-photon emission computed tomography.TMLR was performed on the beating heart via a left anterolateral thoracotomy in the fifth intercoseal space.A 800W CO 2 laser machine(PLC System Inc) was used.The transesophageal echocardiography image denotes transmyocardial penetration of 21±5 channels.Result:The mean age of patients was 64±7 years.Past medical history included prior CABG in 4 cases,prior PTCA in 4,prior AMI 66%,hypertension 66% and diabetes mellitus 38%.The mean left ventricular ejection fraction was 51.0%±10.5%. The perioperative mortality was 2% and post-operative complications were AMI in patient(2%),left ventricular failure in (2%)and PVC in 3(6%).The mean angina class(Canadian Cardio-vascular Society)was significantly improved at 3 momths after operation and furtherimprovement occurred during 6-12 months postoperatively. 201 TI-SPECT showed a remarkable improvement in reversible ischemia in 70% of follow-up patients.Conclusion:A sole TMLR is a safe and effective procedure for treatment of end stadge CHD especially for those not amenable to PTCA or CABG.The better result would be achieved with full preoperative preparation,correct evaluation of mycoardial ischemia,better anaesthesia and succeed perioperative management.

关 键 词：激光 心肌血运重建术 冠心病 心绞痛 

分 类 号：R541.405[医药卫生—心血管疾病]