CSWT治疗冠状动脉粥样硬化性心脏病合并心力衰竭患者的临床效果观察

Observation on clinical effect of extracorporeal cardiac shock wave therapy in coronary heart disease complicating heart failure

目的探讨体外心脏震波(CSWT)治疗对冠状动脉粥样硬化性心脏病(CAD)合并心力衰竭患者的有效性及其机制。方法选取2015年1月至2016年6月该院收治的180例CAD合并心力衰竭患者,分为观察组和对照组各90例,两组均给予至少2个月常规药物治疗,观察组在此基础上行CSWT治疗(3个月内共9次);对照组给予假震波治疗,即不予振波能量。在两组患者治疗前及治疗后分别观察左心室舒张末期内径(LVEDD)、左心室射血分(LVEF),左心室灌注及代谢评分,纽约心功能分级(NYHA)、心绞痛分级(CCS)、周硝酸甘油用量、评分情况(SAQ)及血浆肌钙蛋白(cTn-Ⅰ)、脑钠肽(BNP)及血管内皮生长因子(VEGF)水平变化。结果治疗前两组患者的LVEDD、LVEF,左心室灌注及代谢评分,NYHA、CCS、硝酸甘油用量、SAQ及cTn-Ⅰ、BNP及VEGF水平比较差异无统计学意义(均P>0.05);治疗后两组患者的上述指标中,除cTn-Ⅰ水平无明显变化外,其他指标均较治疗前有明显改善,差异具有统计学意义(均P<0.05),且观察组改善程度明显优于对照组,差异具有统计学意义(均P<0.05)。结论 CSWT治疗CAD合并心力衰竭患者的临床疗效显著,其机制可能与促进血管再生、改善心肌灌注及代谢有关。

Objective To investigate the effectiveness and mechanism of extraeorporeal cardiac shock wave therapy（CSWT） in the patients with coronary atherosclerotic heart disease（CAD） complicating heart failure. Methods One hundred and eighty cases of CAD complicating heart failure in this hospital From June Z015 to June 2016 were selected and divided into the observation group and control group, 90 cases m each group. The two groups were given the roune medication therapy for at least 2 months. On this basis the Observation group conducted extracorporeal CSWT therapy（9 times within 3 months）, the control group was given the sham shockwave treatment without giving shockwave energy, before and after treatment were observed The left ventricular end di- astolic diameter（LVEDD）, left ventricular ejection fraction（LVEF）, left ventricular perfusion and metabolic score, NYHA heart function grade,CCS angina grade, nitroglycerin dosage, SAQ score and plasma cTn-I , BNP and VEGF level changes in the two groups were observed before and after treatment. Results LVEDD, LVEF,le{t ventricular perfusion and metabolic score, NYHA heart function grade and CCS angina grade, nitroglycerin dosage, SAQ scores and plasma cTn- I , BNP and VEGF levels before treatment had no statistical differences between the two groups（P〉0. 05） ;among the above indicators in the two groups,except the cTn-I had no obvious change, the other indicators alter treatment were significantly improved,the differenee was statistically significant（P〈0.05）, moreover the improvement degree of the observation group was obviously superior to that of the control group, the difference was statistically significant（P〈0. 05）. Conclusion CSWT has significantly clinical effect in treating CAD complicaring heart failure,its mechanism may be related with promoting vascular regeneration and improving myocardial perfusion and metabolism.