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目的报告和分析经皮激光心肌血运重建术(PMR)治疗严重冠心病患者的疗效和随访结果。方法采用EclipseTMR 2000DP钬激光系统行PMR,激光输出能量4J、功率3.5W、波长2.1uM、脉宽200uS。结果34例PMR操作全部完成,平均每例打孔22±6个,术后,加拿大心脏协会(CCS)心绞痛级别由术前3.2±0.4减轻至0.5±0.6(P<0.01),心绞痛减轻大于或等于Ⅱ级或消失的病例占85.3%,LVEF(n=22)由治疗前0.45±0.12增加至0.57±0.13(P<0.01);多数患者心电图缺血型ST-T改变有程度不同的改善;ECT(n=13)示缺血改善者8例。平均随访(48±9)个月,平均CCS心绞痛级别为0.7±0.8,较术前改善大于或等于Ⅱ级者仍占79.4%。并发症包括:术中激光脉冲发放时均有室性期前收缩;急性心包填塞3例,其中1例经抢救后死于心源性休克。结论对反复发作心绞痛的严重冠心病患者,PMR是一种安全和有效的治疗选择,能够显著改善临床症状和心肌缺血。
Objective To report and analyze the efficacy and follow-up of percutaneous laser revascularization (PMR) in patients with severe coronary heart disease. Methods EclipseTMR 2000DP holmium laser system PMR, the laser output energy 4J, power 3.5W, wavelength 2.1uM, pulse width 200uS. Results All 34 PMR operations were completed, with an average of 22 ± 6 punctures. After operation, the angina pectoris level of the Canadian Heart Association (CCS) was reduced from 3.2 ± 0.4 to 0.5 ± 0.6 (P <0.01) 85.3% of patients were equal to grade II or disappeared, and LVEF (n = 22) increased from 0.45 ± 0.12 to 0.57 ± 0.13 before treatment (P <0.01); most patients had different degrees of ST-T changes in ECG; ECT (n = 13) showed improvement in 8 cases. With a mean follow-up of 48 ± 9 months, the mean CCS angina pectoris level was 0.7 ± 0.8, still accounting for 79.4% of the patients with improvement of grade Ⅱ or higher. Complications included: intraoperative laser pulse both ventricular contraction; acute cardiac tamponade in 3 cases, of which 1 died of cardiogenic shock after rescue. Conclusions PMR is a safe and effective treatment option for patients with severe coronary heart disease with recurrent angina pectoris and can significantly improve clinical symptoms and myocardial ischemia.