高功率CO_2激光心肌血运重建术50例临床报告  

Transmyocardial Laser Revascularization with High PowerCO2 Laser : Clinical Report with 50 Cases

作　　者：屈正[1] 张兆光[1] 叶建光[1] 于建波[1] 孙衍庆[1] 党海明[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科

出　　处：《中国激光医学杂志》1999年第2期71-74,共4页Chinese Journal of Laser Medicine & Surgery

基　　金：北京市科委科技新星计划资助

摘　　要：目的总结应用高功率ＣＯ２激光对５０例冠心病患者实施激光心肌血运重建术（ＴＭＬＲ）的临床经验并初步评价ＴＭＬＲ的临床效果。方法经左前外侧第五肋间或肋床小切口进胸，在心脏跳动下行ＴＭＬＲ。分析术中使用的激光能量及左心室各壁穿透率。采用酶动力学法监测围术期心肌酶变化，以评价心肌损伤。术后随访患者心绞痛及心肌灌注的改善情况。结果术后８ｈ血清肌酸磷酸激酶同工酶（ＣＰＫＭＢ）较术前明显升高（Ｐ＜００５），２４ｈ达峰值，为４０ＩＵ／Ｌ±２４ＩＵ／Ｌ，但未超过术前（１５ＩＵ／Ｌ±１０ＩＵ／Ｌ）的２倍。全组每孔平均使用脉冲激光能量为３５．６Ｊ±１２．３Ｊ，平均穿透率为９３．６％；心尖处使用激光能量最大（３７．４Ｊ±１０．８Ｊ），穿透率则最低（８３．８％）。术后３、６、１２个月心绞痛分级分别为２．１±０．３、１．７±０．３、１．７±０．３，较术前（３．７±０７）均有明显改善（均为Ｐ＜０．０５）。术后单光子发射型计算机断层扫描示心肌灌注有不同程度的改善。术后早期（３０天内）死亡率为２％（１／５０）。结论应用高功率ＣＯ２激光施行ＴＭＬＲ安全、有效。ＴＭＬＲ可明显缓解心绞痛，改善心肌灌注。术中打孔顺序适当可缩短手术时间，游离心?Objective This paper reports the clinical experience in transmyocardial laser revascularization(TMLR) with high power(800W) CO2 laser and evaluates the preliminary results of TMLR. Methods TMLR was performed on the beating heart in 50 cases of coronary artery disease(CAD) underwent a left anterolateral thoracotomy in the fifth intercostal space. The laser energy of each discharge and the percentage of successful transmyocardial penetration in free walls of the left ventricle were studied. Myocardial enzymes were measured postoperatively by the enzyme dynamic method for a week. The followup ranged from 3 to 18 months was made to assess angina class and myocardial perfusion. Results Creatine phosphokinase isoenzyme (CPKMB) had increased since 8 hours after TMLR, but the peak value of CPKMB at 24 hours was less than 2fold of the baseline(15 IU/L10 IU/L). The average laser energy used for making each channel was 35.6 J12.3 J. The percentage of successful penetration was 93.6%. The energy dose used in aispex was the highest ( PT5BZ<0. 05). The mean angina class(Canadian Cardiovascular Society) was significantly improved (2.10. 3) at 3 months after operation than the average baseline angina class of 3707, P <0.05) and was further improved during 612 months (1.70.3,WT5BXP <0.05). 201 TlSPECT showed a remarkable improvement in reversible ischemia in seventy percent of followedup patients. The mortality during hospitalization was 2%. Conclusions TMLR using high power(800 W) CO2 laser is safe and effective in treatment of the endstage CAD patients. TMLR may improve angina pectoris and myocardial perfusion significantly. To switch on the laser in proper order may be helpful to shorten duration of surgery. A gentle removal of fat on the apex may increase the successful transmyocardial penetration.

关 键 词：心肌血运重建术 激光手术 心绞痛 

分 类 号：R654.2[医药卫生—外科学]