体外心脏震波治疗顽固性心绞痛的有效性和安全性  

Efficacy and safety of extracorporeal cardiac shock wave therapy for intractable angina

作　　者：刘伟静[1] 沈建颖[1] 朱梦云[1] 张毅[1] 范雪华[1] 徐亚伟[1] 

机构地区：[1]同济大学附属第十人民医院心内科,上海200072

出　　处：《上海医学》2017年第4期206-209,共4页Shanghai Medical Journal

基　　金：上海申康医院发展中心新兴前沿资助项目(03.01.15.002)

摘　　要：目的探讨体外心脏震波治疗(CSWT)顽固性心绞痛的有效性和安全性。方法随机入选顽固性心绞痛患者45例,按4∶1的比例随机分成治疗组(36例)和对照组(9例)。治疗前经心肌灌注显像(静息+运动负荷)检查明确存在可逆性心肌缺血节段,并定位为治疗节段。以12周为1个疗程,第1、5、9周的周一、周三、周五应用震波治疗仪对患者行CSWT,治疗组给予能量0.09mJ/mm^2,对照组不予震波能量。比较患者治疗前后的加拿大心血管病学会(CCS)心绞痛分级、西雅图心绞痛量表(SAQ)评分、6min步行距离(6MWT)和每周硝酸甘油使用次数,并记录治疗期间的不良事件发生情况。结果与治疗前比较,治疗组治疗后的CCS心绞痛分级显著降低(P<0.05),每周硝酸甘油使用次数显著减少(P<0.05),SAQ评分、6MWT均显著增加(P值均<0.05)。对照组治疗前后CCS心绞痛分级、SAQ评分、6MWT和每周硝酸甘油使用次数的差异均无统计学意义(P值均>0.05)。所有患者均完成9次CSWT,无不良事件和不良反应发生。结论 CSWT作为一种无创的治疗方案,可以有效改善顽固性心绞痛患者的心绞痛发作频率和运动耐量,提高患者的生活质量。Objective To evaluate the efficacy and safety of extracorporeal cardiac shock wave therapy （CSWT） for intractable angina. Methods Forty-five patients with intractable angina were randomly divided into treatment group （n=36） and control group （n = 9） according to the proportion of 4： 1. Before treatment, single photon emission computerized tomography （SPECT） was applied to locate reversible ischemic segments. Shock waves were applicated with a commercially available cardiac shock wave generator system （Storz Modulith SLC, Switzerland）. The CSWT regimen was performed 3 times per week （Monday, Wednesday and Friday） every 4 weeks for 12 weeks. Canadian Cardiovascular Society （CCS） grade of angina, Seattle Angina Questionnaire （SAQ） score, 6-minute walking distance （6MWT） and weekly dosage of nitroglycerin were evaluated before and after treatment. The adverse events were also recorded during the treatment. Results CCS grade and weekly dosage of nitroglycerin were significantly decreased after treatment in the treatment group, while SAQ score and 6MWT were significantly increased （all P〈0.05）. There was no significant difference in the CCS grade, SAQ score, 6MWT or weekly dosage of nitroglycerin in the control group before and after treatment （all P〉0.05）. All the patients completed 9 sessions without procedural complications or adverse effects. Conclusion CSWT is safe and effective in reducing clinical symptoms and improving exercise tolerance in patients with intractable angina.

关 键 词：心绞痛 顽固性 体外心脏震波 血管新生 

分 类 号：R541.4[医药卫生—心血管疾病]