体外心脏震波治疗老年冠心病患者的疗效和安全性分析

摘要

目的 探讨体外心脏震波系统(CSWT)治疗老年冠心病患者的有效性和安全性. 方法 11例顽固性心绞痛的老年冠心病患者.根据心肌核素显像和冠状动脉造影结果确定缺血心肌靶目标,行CSWT治疗.疗程为3个月,共治疗9次.疗效评价分别采用临床症状描述、加拿大心血管学会心绞痛(CCS)分级、6 min步行试验、纽约心功能心脏病学会心功能(NYHA)分级、西雅图心绞痛量表(SAQ)、硝酸甘油使用量、左心室舒张末期直径(LVEDD)和左心室射血分数(LVEF)等;心肌核素显像评价治疗前后心肌缺血改善情况;观察患者治疗过程中症状、心电监测、血压和氧饱和度变化、治疗后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T、丙氨酸氨基转移酶(ALT)、肌酐、脑钠肽和超敏C反应蛋白(HsCRP)的变化评价其安全性. 结果 CCS分级、NYHA分级、6 min步行试验和硝酸甘油用量在治疗第4个月和1年与治疗前相比均有改善(P＜0.05).心绞痛稳定状态和疾病认识程度有明显改善,较治疗前差异均有统计学意义(P＜0.05).共治疗21个节段,治疗后静息状态心肌缺血的改善率为46.2％(6/13),其中有效率为38.5％ (5/13),明显有效率为7.8％(1/13);负荷状态心肌缺血的改善率为57.1％(12/21),其中有效率为47.6％(10/21),明显有效率为9.5％(2/21).与治疗前比较,CK、CK-MB、肌钙蛋白、ALT、肌酐、脑钠肽和HsCRP均无明显改变,心率、收缩压、舒张压和氧饱和度亦无明显变化. 结论 CSWT是一种安全、有效治疗老年冠心病患者的方法,并能保持疗效至少1年.%Objective To evaluate the efficacy and safety of cardiac shock wave therapy(CSWT) in coronary heart disease in elderly patients.Methods Eleven patients with refractory angina pectoris were enrolled.The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography,and treated with CSWT.The CSWT were performed during treatment of 3 months,with 9 times totally.The clinical evaluations included the clinical symptoms,Canadian Cardiovascular Society (CCS) class scores,New York Heart Association class (NYHA),Seattle angina questionnaire (SAQ),6-min walking distance and the use of dosage of nitroglycerin,left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).The amelioration of ischemic myocardial was analyzed by SPECT.The safety of CSWT was evaluated by changes in clinical symptoms,ECG monitoring,blood pressure and oxygen saturation,blood levels of creatine kinase,creatine kinase myocardial band isoenzymes (CK-MB),troponin T (TnT),alanine transfer enzyme (ALT),creatinine (CR),brain natriuretic peptide and high sensitive C reactive protein (hs CRP).Results The CCS class scores,NYHA,6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment.The steady state of angina pectoris and the frequency score in SAQ were significantly improved.The 21 cardio-vessel segments were treated,and the improvement rate of resting myocardial perfusion was 46.2％ (6/13),the effective rate was 38.5％ (5/13),and the obvious effective rate was 7.8％ (1/13) after treatment.The improvement rate of loaded myocardial perfusion was 57.1％ (12/21),the effective rate was 47.6％ (10/21),and the obvious effective rate after treatment was 9.5％ (2/21).There were no significant changes in levels of CK,CK-MB,TNT,ALT,Cr,BNP and hs CRP,heart rate,systolic blood pressure,diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment.Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly,and the curative effect could maintain at least one year.