体外心脏震波治疗难治性冠心病的安全性研究

A safety evaluation of extracorporeal cardiac shock wave therapy for refractory coronary heart disease

目的 探讨体外心脏震波治疗难治性冠心病的安全性.方法 应用瑞士STORZ MEDICAL公司生产的震波治疗仪（MODULITH SLC）,对35例冠心病患者进行体外心脏震波治疗.治疗前经小剂量多巴酚丁胺负荷超声心动图（LDDSE）和99m锝-甲氧基异丁基异腈（99mTc-MIBI）心肌灌注显像（MPI）定位缺血节段,识别存活心肌.治疗时经机载实时超声探头锁定缺血靶心肌,联合心电监测,以＂R＂波触发,部分＂R＂波触发不良的患者使用＂1＂触发（每秒发放1次脉冲）,每个靶区实施-1～0～＋1两两组合9点治疗,每点发放200次脉冲,能量0.09mJ/mm2.每个疗程9次治疗.结果 所有患者每个疗程9次治疗,每次治疗和其他次治疗期间心率、血压和氧饱和度差异均无统计学意义（均为P＞0.05）,心律无改变,未见新发心律失常,无明显皮肤损伤,肝酶正常,无血栓栓塞、呼吸困难等不良反应.对部分心电图＂R＂波触发不良的患者使用＂1＂触发,同样未发现致心律失常现象.结论 体外心脏震波治疗是一项无创、安全的疗法,无致心律失常或心肌损伤作用,对心率、心律、血压、氧饱和度、心肌酶、肝酶无影响,治疗无痛苦,患者耐受性好,是治疗难治性冠心病心肌缺血的一项新选择.

Objective To investigate the safety of extracorporeal cardiac shock wave therapy （CSWT） for treatment of refractory coronary artery disease. Methods 35 patients were enrolled for CSWT in our institution. All patients were diagnosed as coronary heart disease and underwent the extracorporeal cardiac shock therapy. Before and after the treatment, low-dose dobutamine stress echocardiography and 99 mTc-MIBI myocardial perfusion were applied to evaluate the viable myocardium and locate the ischemic segments. The shock wave was released by R-wave-triggered manner with low energy （0. 09 mJ/mm2） at 200 shoots/spot for 9 spots. For those whose ECG trigger was not available, shock pulse was released per one second. The whole process was monitored by recording real-time ECG, blood pressure, oxygen saturation and the conditions of patients including skin reaction, palpitations, chest pain, breathing difficulty, and dizziness were detected . ECG and enzyme markers were measured prior to CSWT and at the 3 month after CSWT. Results There were no significant changes in heart rate, rhythm, blood pressure and oxygen saturation during the treatment. Damage of skin was not found. Patients didn＇t experience any serious cardiovascular complications either during or after CSWT. For those whose shock wave was released per one second, aiThythmias were not found. Conclusions Our study have shown that CSWT is a safe and non-invasive method for treatment of coronary artery disease, although further careful evaluation is needed.