经皮激光心肌血运重建术的临床观察  

Clinical use of percutaneous laser myocardial revascularization

作　　者：卢才义[1] 魏璇[1] 黄丛春[1] 刘朝中[1] 王文清[1] 朴龙松[2] 毛树森[1] 

机构地区：[1]空军总医院心内科,北京100036 [2]空军总医院放射科

出　　处：《临床心血管病杂志》1999年第12期537-539,共3页Journal of Clinical Cardiology

摘　　要：目的：观察经皮激光心肌血运重建术（PMR）治疗晚期冠心病（CHD）的临床疗效。方法：应用PMR治疗10例晚期CHD患者，以Seldinger法经右股动脉将激光导管送入左心室腔内，将激光器调节为2脉冲／串，心电同步于T波易损期前3Oms，在透视指导下对缺血左室壁打孔，深度6mm，每个心室壁打孔9～12个。结果：10例男性CHD患者的年龄为（65.2±5．7）岁，心绞痛级别为（3．4±0．5）级，连用（4．3±1．8）种抗心绞痛药物效果不好，左室壁最大舒张期厚度（11．2±0．9）mm，平均打孔（16．7±3．4）个。随访（6．4±3．7）个月，10例患者的心绞痛级别下降为（2.2±0．3）级（P＜0．05），运动耐量由[（327．4±62．8）s增加至（498．6±81．7）s，（P＜0．05）]，抗心绞痛药物使用种类由[（4．3±1．8）种减少至（3．2±0.4）种，P＜0．05]，单光子发射计算机体层摄影术心肌显像缺血明显改善，无并发症。结论：PMR治疗晚期严重心绞痛患者是安全有效的，不损害心功能，没有致心律失常作用。但对CHD患者远期疗效和病死率的影响有待进一步观察。objective:To evaluate the effect of percutaneous laser myocardial revascularization(PMR) on the end-stage of ischemic heart disease. Metbod: Ten patients were selected by:①morethan　Ⅲ class of angina pectoris;②not suitable for CABG;③without myocardial infarction within 6months;④myocardial ischemia confirmed by ECT or ECG;⑤maximum diastolic wall thickness ofleft ventricle (LV) was≥8mm. PMR was completed via Seldinger technique under the direction ofnuoroscopy. channels were made at the density of l/cm2 left ventricular endocardial surface. Re-sult:Ten patients were male with age of (65. 2 ± 5. 7) years and (3. 4 ± 0. 5) class of angina. Theywere refractory to (4. 3±1. 8) kinds of antiangina druges. The maximum LV diastolic wall thick-ness was (11. 2± 0. 9) mm. CAG showed bivessel or trivessel diffuse lesions. Mean (16. 7± 3. 4)myocardial channels were made. During the follow-up of (6. 4±3.7) months,the angina class de-creased from (3.4 ±0. 5 ) to (2. 2±0. 3 ) (P＜ 0.05 ). Exercise tolerance was increased from(327.4 ±62. 8) s to (498. 6±81. 7 )s, P＜0. 05. The kinds of antiangina drugs were decreasedfrom (4. 3±l. 8) to (3. 2±0. 4) (P＜0.05). There were no major complications. Conclusion:It isfeasible and safe of using PMR to treat the end-stage and severe ischemic heart disease. PMR hasno arrhythmogenic effect,dose not impair the heart function. The long-term effect of PMR on rein-farction rate and mortality needs to be further studied.

关 键 词：心肌血运重建术 心绞痛 冠心病 PMR 

分 类 号：R541.405[医药卫生—心血管疾病]