经皮激光心肌打孔对老年终末期冠心病心绞痛的影响

Effect of percutaneous laser transmyocardial revascularization on angina pectoris in elderly patients with end-stage coronary heart disease

目的 观察经皮激光心肌打孔血运重建术治疗老年终末期冠心病心绞痛的临床疗效和对运动缺血阈值的影响。方法 应用经皮激光 (HO∶YAGlaser)心内膜心肌打孔治疗 16例老年终末期冠心病心绞痛患者。结果 每例打孔数 5～ 15个 ,平均 (9± 4)个。按加拿大心绞痛标准分级 ,打孔前为 (3 .3± 0 .6 )级 ,打孔后 1个月为 (2 .0± 0 .9)级 ,打孔后 3个月为 (2 .1± 1.0 )级。将Naughton运动试验ST段下移至 1mm所需时间作为运动缺血阈值指标 ,打孔前为(32 0± 136 )s,打孔后 1个月为 (397± 170 )s,打孔后 3个月为 (4 30± 30 7)s。结论 经皮激光心肌打孔后可降低心绞痛的严重程度 ,对临床有严重心绞痛发生而不宜施行经皮冠状动脉腔内成形术 (PTCA)或冠状动脉搭桥术 (CABG)等干预治疗的老年终末期冠心病心绞痛患者 ,经皮激光心肌打孔术是一种新颖而有效的治疗方法。

Objective To observe the clinical efficacy of percutaneous transmyocardial revascularization with holmium: YAG laser on the angina pectoris in elderly patients with end-stage coronary heart disease.Methods 16 cases of angina pectoris in elderly patients with end-stage coronary heart disease were treated by using percutaneous transmyocardial revascularization (PTMR) with holmium: YAG laser.Results To test the clinical efficacy of PTMR, the angina pectoris class of Canadian Cardiovascular Society (CCS) and Naughton exercise ischemic threshold, as expressed by time to 1-mm ST segment depression, were examined before and 1-month and 3-month after PTMR. The number of channels created by PTMR were from 5～15 with an average of 9±4. The mean CCS class was 3.3±0.6 before PTMR and fell to 2.0±0.9(P<0.0001)at 1-month and to 2.1±1.0(P<0.0001)at 3-month after PTMR, respectively. Time to 1-mm ST segment depression was 320±136 sec before PTMR,397±170 sec at 1-month and 430±307 sec at 3-month after PTMR, respectively.Conclusions The present clinical observation demonstrates that PTMR can be used as a novel therapeutic approach for elderly patients with end-stage angina pectoris untreatable by PTCA and CABG.