经皮激光心肌打孔治疗顽固性心绞痛(附11例报告)

Percutaneous transmyocardial revascularization with laser:a new therapeutic approach for refractory angina pectoris

目的：观察新近发展的经皮激光心肌打孔术治疗慢性顽固性心绞痛的临床疗效。方法：应用经皮激光（ Ｈ Ｏ： Ｙ Ａ Ｇ ｌａｓｅｒ）心内膜心肌打孔治疗 １１ 例顽固性心绞痛和对运动缺血阈值的影响。结果：每例打孔数为６～１５（１０．５±２．７）个。按照加拿大心绞痛分级，打孔前为（３．６±０．５）级，打孔后７ ｄ 为（１．５±０．５）级和打孔后３０ ｄ 为（１．６±０．５）级（均 Ｐ ＜ ０．０１）； Ｎａｕｇｈｔｏｎ 运动试验显示总运动耐量时间，由打孔前（５．０５±１．２８）ｍ ｉｎ 增加到（７．０５±４．０６）ｍ ｉｎ； Ｓ Ｔ 段下移 １ ｍ ｍ 所需时间，由打孔前（４．２４±１．０５）ｍ ｉｎ 延长到（５．２±３．４）ｍ ｉｎ，且从临床观察该疗法能有效的控制顽固性心绞痛发作的程度和频率，改善心肌的灌注和提高运动后缺血耐量阈值。结论：与外科的开胸激光心肌打孔比较，经皮心内膜心肌打孔，具有不需开胸、手术创伤小、避免全麻且可重复施行治疗等优点。对不适于作经皮腔内冠状动脉成形术或冠状动脉旁路搭桥术等干预治疗的顽固性心绞痛患者，若经上述干预治疗后症状仍不缓解者，经皮激光心肌打孔术是一新颖而有效的治疗方法。

Objective:To observe the clinical effect of percutaneous transmyocardial revascularization with holmium:YAG laser in treatment of refractory angina pectoris.Method:11 cases of refractory angina pectoris were treated with percutaneous transmyocardial revascularization (PTMR) with holmium:YAG laser.Result:To test the clinical efficacy of PTMR,CCS angina class was exmined in 11 patients with severe chronic angina pectoris due to 3 vessel disease not suitable for PTCA and CABG,before and 7 days and 30 days after PTMR.Exercise stress test was also performed to assess the improvement in exercise ischemic capacity.Improvement of angina according to CCS angina class was significant at 7 days after the procedure compared to baseline status ( 1.5 ± 0.5 vs. 3.6 ± 0.5 ,P< 0.01 ),and was maintained at 30 days ( 1.6 ± 0.5 ,P< 0.01 ).Total exercise time increased from ( 5.05 ± 1.28 ) min to ( 7.05 ± 4.06 ) min.though not significantly.Time to 1 mm horizontal ST segment depression was much the same in 6 patients and increased markedly in one from 3.4 min to 11.25 min,giving rise to a slightly higher mean value after ( 5.2 ± 3.4 ) min than before ( 4.24 ± 1.05 ) min.Conclusion:The present clinical observation shows that PTMR can relieve the attack of refractory angina pectoris and improve exercise capacity,which indicates that PTMR may be used as a new promising therapeutic approach for patients with refractory angina pectoris untreatable by PTCA and CABG.