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目的观察CO2激光跨心肌血管成型术(PTMR)对晚期冠心病心肌灌注的影响。方法病人共计42人,男女性别配对,分为激光治疗组和药物治疗组。激光治疗组,男,18例,女3例,年龄51-67(58±8)岁,陈旧性心肌梗死16例,糖尿病合并顽固性心绞疼5例。LVEF35-47(38±13)%,冠状动脉造影示三支血管病变,不适宜做PCI和CABG手术。药物治疗组,男,16例,女5例,年龄53-71(59±10)岁,陈旧性心肌梗死15例,糖尿病合并顽固性心绞疼6例。LVEF36-47(38±14)%,冠状动脉造影示三支血管病变,不适宜做PCI和CABG手术。激光仪:CO2激光。用99锝测定TMLR术后3、6、12个月心肌再灌注的变化(ECT),用超声心动图检测左室射血分数(LVEF)、左室舒张末期容量(LVEDV)。结果21例病人,17例手术顺利,住院期间无死亡。4例病人在术中,因激光击穿出现心包填塞,而行急诊冠状动脉搭桥术(CABG)。3月后,运动和静息ECT显示TMLR病人,运动缺血积分分别为(0.172±0.003和0.161±0.003,P<0.01),静息为(0.170±0.003和0.158±0.003,P<0.01)。6个月缺血积分运动状态PTMR病人为0.176±0.003,对照组为0.162±0.003(P<0.01),静息状态下无区别。12个月时,静息和运动状态下,两组病人无区别。激光区缺血严重程度积分明显比对照组高,3,6,12个月P值前壁均小于0.01,心尖为P<0.01,P<0
Objective To observe the effect of CO2 laser transmyocardial angioplasty (PTMR) on myocardial perfusion in patients with advanced coronary heart disease. Methods A total of 42 patients, males and females paired, divided into laser treatment group and drug treatment group. Laser treatment group, 18 males and 3 females, aged 51-67 (58 ± 8) years old, 16 cases of old myocardial infarction, 5 cases of diabetic patients with refractory angina pectoris. LVEF35-47 (38 ± 13)%, coronary angiography showed three vascular lesions, unsuitable for PCI and CABG surgery. There were 16 males and 5 females, aged 53-71 (59 ± 10) years, 15 with old myocardial infarction and 6 with diabetes and refractory angina. LVEF36-47 (38 ± 14)%, coronary angiography showed three vascular lesions, unsuitable for PCI and CABG surgery. Laser: CO2 laser. The changes of myocardial reperfusion (ECT) at 3, 6, and 12 months after TMLR were measured by 99 technetium. Left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) were measured by echocardiography. Results 21 patients, 17 cases of surgery smoothly, no death during hospitalization. Four patients underwent surgery for coronary artery bypass grafting (CABG) undergoing pericardial tamponade due to laser puncture. After 3 months, exercise and resting ECT showed that the scores of locomotor ischemia in TMLR patients were (0.172 ± 0.003 and 0.161 ± 0.003, P <0.01, respectively) and resting values were (0.170 ± 0.003 and 0.158 ± 0.003, P <0.01). The 6-month ischemic score was 0.176 ± 0.003 for PTMR patients and 0.162 ± 0.003 for controls (P <0.01), with no difference at rest. At 12 months, there was no difference between the two groups when resting and exercising. The severity of ischemia in the laser area was significantly higher than that in the control group. The anterior wall of P value at 3, 6 and 12 months were less than 0.01, P <0.01, P <0