增强型体外反搏治疗非高危稳定型心绞痛患者的疗效

Efficacy of enhanced external counterpulsation in the treatment of non-high risk stable angina pectoris

目的研究增强型体外反搏治疗非高危稳定型心绞痛患者的疗效。方法将100例非高危稳定型心绞痛患者随机分为反搏组(48例)和对照组(52例),对照组常规口服阿司匹林、调脂药物、硝酸酯类药物、β肾上腺素能受体阻滞剂和(或)钙拮抗剂,反搏组在服用药物的基础上加2个疗程体外反搏(每周6d,每天1次,每次1h)。在治疗结束后第12周,观察患者的心绞痛发作次数、持续时间和硝酸甘油用量,采用西雅图心绞痛量表从躯体活动受限程度(PL)、心绞痛稳定状态(AS)、心绞痛发作情况(AF)、治疗满意程度(TS)和疾病认知程度(DP)5个维度评价患者的心绞痛情况,进行运动平板试验(主要观察指标有运动总时间、运动总做功、运动至ST段压低1mV的时间、运动至ST段压低的最大幅度)评定疗效。在治疗前和治疗结束后第12周,应用24h动态心电图检测心肌缺血总负荷(TIB)。记录主要心血管不良事件(MACE,包括心血管死亡、心肌梗死、需行血管重建术、心绞痛恶化需再次住院)。结果治疗后12周,反搏组和对照组PL、AS、AF、TS、DP这5个维度的评分均显著高于同组治疗前(P值分别<0.01、0.05),反搏组又显著高于对照组(P值均<0.05)。反搏组的治疗总有效率为85.4%,显著高于对照组的63.5%(P<0.05)。治疗后12周,反搏组平均每周舌下含化硝酸甘油(1.5±1.1)片,显著少于对照组的(3.0±1.9)片(P<0.05)。反搏组的运动总时间、运动总做功、运动至ST段压低l mV的时间和运动后ST段压低的最大幅度均显著大于对照组(P值分别<0.01、0.05)。治疗后12周,反搏组和对照组的TIB均显著低于同组治疗前(P值均<0.05),反搏组又显著低于对照组(P<0.05)。3个月内两组患者均未发生心血管死亡、心肌梗死,反搏组行血管重建术和因心绞痛恶化入院的患者构成比均显著低于对照组(P值均<0.05)。结论在常规使用抗心绞痛药物的基础上加用体外反搏治疗,可使非高危稳定型心绞痛的症状减轻,运动耐量增加,MACE发生率下降。

Objective To evaluate the clinical effect of enhanced external counterpulsation in patients with non-high risk stable angina pectoris. Methods One hundred patients with stable angina pectoris were randomly divided into two groups： counterpulsation group （n = 48） and control group （n = 52）. All patients were given aspirin, blood-lipids regulator, nitrates, beta-blocker and （or） calcium antagonists. Patients in the counterpulsation group were additionally given enhanced external counterpulsation for two courses （1 hour daily, 6 times weekly）. The total number and duration of angina attack, dosage of nitroglycerin were collected 12 weeks after treatment. Seattle angina scale was used to assess the degree of angina from physical limitation （PL）, anginal status （AS）, anginal frequency （AF）, treatment satisfaction （TS） and disease perspective （DP）. Treadmill exercise testing （TET, main parameters; exercise total time, exercise total work load, time to 1 mV ST segment depression, the maximum ST segment depression） was used to evaluate clinical outcomes. Total ischemia burden （TIB） was assessed by Holter monitor before and 12 weeks after treatment. Major adverse cardiovascular events （MACE）, such as cardiovascular death, myocardial infarction, need of vascular reconstruction, and rehospitalization caused by deteriorated angina, were recorded. Results The scores of PL, AS, AF, TS and DPat 12 weeks after treatment were significantly higher than those before treatment in both groups （P〈0.05, 0.01）, and those scores in the counterpulsation group were significantly higher than those in the control group at 12 weeks after treatment （all P〈0.05）. The total effective rate of the counterpulsation group was significantly higher than that of the control group （85. 4% vs. 63. 5%, P〈0. 05）. The mean weekly sublingual administration of nitroglycerin in the counterpulsation group was （1.5± 1.1） tablets, which was significantly less than that in the control group （[3.0±1.9] tablets, P〈0.05）. The results of TET in the counterpulsation group were significantly higher than those in the control group （P〈0.05, 0.01）. TIB at 12 weeks after treatment were significantly lower than that before treatment in both groups （both P,〈0.05）, and TIB in the counterpulsation group were significantly lower than that in the control group at 12 weeks after treatment （P〈0.05）. No cardiovascular death or myocardial infarction occurred within 3 months after treatment. The proportion of patients who received vascular reconstruction and were hospitalized again in the counterpulsation group was significantly lower than that in the control group （both P〈0.05）. Conclusion Conventional anti-angina treatment with enhanced external counterpulsation can decrease symptoms of non-high risk stable angina pectoris and the incidence of MACE, and increase exercise tolerance.