经皮激光心肌血运重建术的初步临床应用(附14例报告)  

Effect evaluation of percutaneous laser myocardial revascularization in fourteen Chinese patients with refractory angina pectoris

作　　者：卢才义[1] 魏璇[1] 黄丛春[1] 刘朝中[1] 毛树森[1] 朴龙松[1] 刘姝英[1] 杨淑惠[1] 齐志荣 

机构地区：[1]解放军空军总医院,北京100036

出　　处：《中国介入心脏病学杂志》2001年第2期77-80,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的 初步评价采用钬：ＹＡＧ激光器及其导管系统对冠心病患者行经皮激光心肌血运重建治疗（ＰＭＲ）的方法学和临床疗效。方法 １４例病人均为男性，平均年龄（６３．３ ± ７．５）岁，心绞痛史（７．３±７．０）年。病例选择标准：①药物治疗无效的Ⅲ、Ⅳ级心绞痛；②冠状动脉病变不宜作经皮冠状动脉腔内成形术（ＰＴＣＡ）或冠状动脉旁路移植术；③左室射血分数（ＬＶＥＦ）≥４５％；④６个月内无心肌梗死病史；⑤心电图、平板试验或ＥＣＴ检查有心肌缺血证据；⑥超声检查左室壁最大舒张期厚度≥８ｍm。操作方法：先作ＲＡＯ30°和ＬＡＯ60°左室造影，冻结在最大舒张期作为定位参照；将激光系统心电同步调整在Ｔ波易损期前３0ｍs，校正实际激光能量；经大腔引导管送入激光导管，对缺血左心室壁进行激光打孔，深度控制在６ｍm以内；在屏幕上标示出打孔部位和序号以保护打孔均匀。随访观察心绞痛级别、心电图、心脏超声、ＥCT、心肌酶等。结果 每例平均打孔（１７．５ ± ４．１）个，发放脉冲（６８．１± ９．３）个，能量（ １３５．８ ± １８．２）Ｊ．ＰＭＲ操作中病人无不适，操作时间（ ８７．５ ± ２４．３） min， Ｘ线透视时间（２３．5±７．６）min。未发生心包填塞等并发症。随访（Objective Evaluate the feasibility, safety and effect of the percutaneous laser myocardial revascularization (PMR) with Holmium: YAG laser generator and its affiliated catheter system in the treatment of Chinese patients (pts) with refractory Ⅲ～Ⅳ class of angina pectoris (Canadian criteria). Methods Fourteen pts were all male, 63.3 ± 7.5 years old, with the history of angina 7.3 ± 7.0 years, refractory to 4.4 ± l.5 antiangina drugs. The angina of nine pts was CAC class Ⅳ and another five was class Ⅲ. Myocardial ischemia was confirmed by Treadmill ECG or SPECT. All pts had a normal LV size and the maxmum diastolic wall thickness was 10.8 ± 1 .6 mm. LVEF was 48.7 ± 5.6%. Eleven pts had trivessel coronary diffuse lesions and three had bivessel diffuse lesion. Pts were selected by the criteria of : ①more than Ⅲ class of angina pectoris; ②the angina was refractory to more than three antiangina drugs; ③not suitable for CABG/PTCA; ④LVEF was greater or equal than 45%; ⑤without myocardial infarction within 6 months; ⑥myocardial ischemia confirmed by ECT or exercise test ECG; ⑦maxmum diastolic wall thickness of left ventricle (LV) was greater than 8 mm measured by echocardiography (ECHO). MLA1 Holmium: YAG generator and PMRL1 catheter system (Cardio Genesis Corp. ) were used. PMR procedure steps include: ①double plane LV angiogram was conducted and the maximum diastolic imagines were freezen; ②laser system was calibrated; ③laser catheter was inserted into LV via guide tube; ④ endomyocardial with deepth of 6 mm were made in the target LV walls and marked on the biplane screens; ⑤LV angiogram was repeated. Angina class, ECG, ECT, Holter and LV late potential were followed-up after PMR. Results Mean 17.5 ± 4.1 myocardial channels were made in 3 ± 0.7 LV wall. The numbers of laser pulses and enjergy were 68.1 ± 9.3 and 135.8 ± 18.2 J respectively. Total procedure time was 87.5 ± 24.3 min and X radiation time was 23.5 ± 7.6 min. There were no major or minor complications. Duri

关 键 词：激光 心肌血运重建术 心绞痛 临床应用 

分 类 号：R454.2[医药卫生—治疗学]