激光心肌血管重建术联合升压法治疗不稳定心绞痛6例报道

Percutaneous transluminal laser myocardial revascularization combined with pressure elevation in the management of unstable angina pectoris

目的 为探讨激光打孔联合适当升压从而提高激光孔道血流量的方法治疗不稳定心绞痛的效果。方法 本文 6例严重不稳定心绞痛患者 ,Braunwadd评分 7分 4人 ,8分 2人 ,冠造发现多支冠脉严重病变 4例 ,弥漫血管病变 2例 ,不适合PTCA拒绝搭桥术 ,经同意在冠脉造影术后行激光心肌血管重建术 (PTMR) ,术后通过适当提高血压的办法提高灌注区 ,通过多项指标观察来评价重建血管对不稳定心绞痛的治疗作用。选择前壁及高外侧壁进行激光打孔 ,术后随机分为两组 ,升压组给高盐饮食 ,麻黄素滴鼻与口服 ,血压升高 10 %～ 2 0 % ,未升压为对照组。结果 术后患者心绞痛发作次数减少 ,由 3～ 5次 /2 4h ,减少为 1～ 3次 /月 ,升压组基本上停止发作 ,对照组仍有发作 ,时间缩短 ,未超过 5min ,次数明显减少 ,Braunwadd评分 ,3分、4分 ,加压组运动耐量由术前 (2 80± 30 )s增加到术后 (46 0± 40 )s,对照组升高 (380± 35 )s,两组间有明显差异 (P <0 0 1) ,心电图显示ST段由压低 2mm以下 ,恢复至 1mm内 ,升压组 2例完全恢复正常 ;M型超声示狭窄血管支配区域活动增强 ;EF值 :升压组 (18± 6 ) % ,对照组升高 (12± 4) % (P <0 0 1) ;左心显影心肌染色显示术后造影较局限 ,密度较高 ,于第 12周显示面积增大 ,升压组比对照组?

Objective To assess the effect of postoperative pressure elevation on myocardial laser channel perfusion function. Methods A total of 6 patients with unstable angina (UA) underwent percutaneous transluminal laser myocardial revascularization (PTMR) were included in the study, all cases had serious angina according to the Braunwald classification. Among these, 2 cases had 7 marks and 8 marks in the other 4 cases. After routine coronary angiography, the region of myocardium supplied by the diseased arteries was punctured by laser. Patients were divided into two groups, group A underwent blood pressure elevation, group B used as control. Left ventriculography was performed immediately and 24 weeks after the operations. Results The frequency of angina attacks was reduced from 5～8 times a day to 1～2 times a month in the end. ECG showed that depressed ST segments were elevated from 3～4mm to less than 1mm, grade marks were decreased to about 2 and 3. No angina attacks was found 12～13 weeks postoperatively in group A. Group B had a cessation of angina untill 16～20 weeks. The SPECT showed that mean EF of group A has increased over (18±5)% , only (12±4)% in group B. The ventriculography myocardial intensity showed that the dyed area of contrast medium distribution increased by 3～5 times in group A in 24 weeks postoperatively and only 1～2 times in the control group. Conclusion This study indicates that elevation of the blood flow volume through the laser channel via the pressure elevation postoperatively of PTMR has a significant effectiveness on the treatment of UA.