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目的探讨体外心脏震波治疗难治性冠心病的安全性。方法应用瑞士STORZ MEDICAL公司生产的震波治疗仪(MODULITH SLC),对35例冠心病患者进行体外心脏震波治疗。治疗前经小剂量多巴酚丁胺负荷超声心动图(LDDSE)和~(99)m锝-甲氧基异丁基异腈(~(99)mTc-MIBI)心肌灌注显像(MPI)定位缺血节段,识别存活心肌。治疗时经机载实时超声探头锁定缺血靶心肌,联合心电监测,以“R”波触发,部分“R”波触发不良的患者使用“1”触发(每秒发放1次脉冲),每个靶区实施-1～0～+1两两组合9点治疗,每点发放200次脉冲,能量0.09mJ/mm~2。每个疗程9次治疗。结果所有患者每个疗程9次治疗,每次治疗和其他次治疗期间心率、血压和氧饱和度差异均无统计学意义(均为P>0.05),心律无改变,末见新发心律失常,无明显皮肤损伤,肝酶正常,无血栓栓塞、呼吸困难等不良反应。对部分心电图“R”波触发不良的患者使用“1”触发,同样未发现致心律失常现象。结论体外心脏震波治疗是一项无创、安全的疗法,无致心律失常或心肌损伤作用,对心率、心律、血压、氧饱和度、心肌酶、肝酶无影响,治疗无痛苦,患者耐受性好,是治疗难治性冠心病心肌缺血的一项新选择。
Objective To investigate the safety of extracorporeal shock wave in the treatment of refractory coronary heart disease. Methods Thirty-five patients with CHD were treated with heart-wave therapy by MODULITH SLC (STORZ MEDICAL, Switzerland). Low-dose dobutamine stress echocardiography (LDDSE) and ~ (99) m technetium-methoxyisobutylisonitrile (~ (99) mTc-MIBI) myocardial perfusion imaging (MPI) Segments, identifying viable myocardium. Treatment by the real-time on-board ultrasound probe to lock the target myocardium ischemia, combined with ECG monitoring, to “R” wave trigger, some “R” wave trigger bad patients use “1 ” trigger 1 pulse). Each target area was treated with a combination of 9 points at a dose of -1 ~ 0 ~ + 1 and 200 pulses per point with an energy of 0.09 mJ / mm ~ 2. Each treatment 9 times treatment. Results All patients treated 9 times each course of treatment, each treatment and other times during the treatment of heart rate, blood pressure and oxygen saturation were no significant difference (both P> 0.05), no changes in heart rate, the last see new arrhythmia, No obvious skin damage, normal liver enzymes, no thromboembolism, dyspnea and other adverse reactions. On the part of the ECG “R ” wave trigger bad patients using “1 ” trigger, also found no arrhythmia. Conclusion Extracorporeal shock therapy is a noninvasive and safe therapy with no arrhythmia or myocardial damage. It has no effect on heart rate, heart rate, blood pressure, oxygen saturation, myocardial enzymes, liver enzymes, and painlessness, patient tolerance Well, is a new option for the treatment of refractory coronary heart disease.