体外反搏技术在冠状动脉粥样硬化治疗中的应用效果

doi:10.3877/cma.j.issn.2095-6568.2018.04.003

目的

探讨体外反搏技术在冠状动脉粥样硬化治疗中的应用效果。

方法

采用回顾性、病例对照研究的方法，收集2015年12月至2016年12月郑州大学第二附属医院收治的220例冠状动脉粥样硬化患者的临床资料，根据治疗方案将患者分为观察组和对照组，各110例。对照组接受标准冠心病药物治疗，观察组在对照组治疗基础上加用体外反搏治疗，连续治疗3个疗程后测定两组患者心输出量(CO)、每搏输出量(SV)、心脏指数(CI)、加速度指数(ACI)等心室功能指标，抽取外周静脉血测定两组患者前列环素(PGI₂)、血栓素A₂(TXA₂)、一氧化氮(NO)、内皮素－1(ET－1)的表达水平。治疗完成后随访3个月，统计两组患者心绞痛、硝酸甘油(NTG)用量、运动耐量等变化情况，对两组各观察指标进行比较，探讨体外反搏技术的应用效果。

结果

治疗后，观察组患者CO、SV、CI、ACI均高于对照组(均P<0.05)。治疗后，观察组患者PGI₂、NO均高于对照组，TXA₂、ET－1均低于对照组，差异有统计学意义(均P<0.05)。观察组患者心绞痛改善率、NTG用量减少率、运动耐量提高率均高于对照组(均P<0.05)。

结论

体外反搏技术能够有效改善冠状动脉粥样硬化患者血管内皮细胞功能，优化相关细胞因子表达，改善心室射血功能，提高治疗有效率和患者运动耐量，保证其生活质量，值得临床推广应用。

关键词: 体外反搏, 冠状动脉粥样硬化, 治疗效果

Objective

To explore the effect of extracorporeal counterpulsation in the treatment of coronary atherosclerosis.

Methods

A retrospective case-control study was conducted. Clinical data of 220 patients with coronary atherosclerosis admitted to the Second Affiliated Hospital of Zhengzhou University from December 2015 to December 2016 were collected. According to the treatment plan, the patients were divided into observation group and control group, 110 cases in each group. The control group was treated with standard coronary artery disease drugs. The observation group was treated with external counterpulsation on the basis of the control group. After three consecutive courses of treatment, cardiac output (CO), stroke output (SV), cardiac index (CI), acceleration index (ACI) and other ventricular function indexes were measured. Peripheral venous blood was taken to measure prostacyclin (PGI₂) and thromboxane A₂ (TXA) in the two groups. The expression levels of TXA₂, nitric oxide (NO), endothelin-1 (ET-1). After 3 months of follow-up, the changes of angina pectoris, nitroglycerin (NTG) dosage and exercise tolerance in the two groups were counted. The observation indexes of the two groups were compared, and the application effect of external counterpulsation technology was discussed.

Results

After treatment, CO, SV, CI and ACI in the observation group were higher than those in the control group (all P<0.05). After treatment, the levels of PGI₂ and NO in the observation group were higher than those in the control group, and the levels of TXA₂ and ET-1 in the observation group were lower than those in the control group (all P<0.05). The improvement rate of angina pectoris, the decrease rate of NTG dosage and the increase rate of exercise tolerance in the observation group were higher than those in the control group (all P<0.05).

Conclusion

External counterpulsation can effectively improve the function of vascular endothelial cells, optimize the expression of related cytokines, improve ventricular ejection function, improve treatment efficiency and exercise tolerance, and ensure the quality of life in patients with coronary atherosclerosis. It is worthy of clinical application.

Key words: External counterpulsation, Coronary atherosclerosis, Therapeutic effect

表1 两组患者治疗后心功能指标对比(±s)

组别	例数	CO(L/min)	SV(mL)	CI[L/(min·m²)]	ACI(/100·s²)
对照组	110	4.7±0.5	70.8±11.6	2.9±2.2	82.5±19.1
观察组	110	5.8±0.8^a	86.3±12.5^a	3.5±2.9^a	98.4±26.7^a

表1 两组患者治疗后心功能指标对比(±s)

组别	例数	CO(L/min)	SV(mL)	CI[L/(min·m²)]	ACI(/100·s²)
对照组	110	4.7±0.5	70.8±11.6	2.9±2.2	82.5±19.1
观察组	110	5.8±0.8^a	86.3±12.5^a	3.5±2.9^a	98.4±26.7^a

表2 两组患者治疗后血清学相关指标对比(±s)

组别	例数	PGI₂(pg/mL)	TXA₂(pg/mL)	NO(nmol/L)	ET－1(ng/mL)
对照组	110	179.8±22.3	97.5±11.7	693.7±25.7	88.0±1.7
观察组	110	248.3±29.4^a	82.4±9.9^a	1 120.7±344.9^a	64.4±1.2^a

表2 两组患者治疗后血清学相关指标对比(±s)

组别	例数	PGI₂(pg/mL)	TXA₂(pg/mL)	NO(nmol/L)	ET－1(ng/mL)
对照组	110	179.8±22.3	97.5±11.7	693.7±25.7	88.0±1.7
观察组	110	248.3±29.4^a	82.4±9.9^a	1 120.7±344.9^a	64.4±1.2^a

表3 两组患者随访结果对比[n(%)]

组别	例数	心绞痛改善	NTG用量减少	运动耐量提高
对照组	110	52(47.3)	44(40.0)	42(38.2)
观察组	110	76(69.1)^a	71(64.5)^a	53(48.2)^a

表3 两组患者随访结果对比[n(%)]

组别	例数	心绞痛改善	NTG用量减少	运动耐量提高
对照组	110	52(47.3)	44(40.0)	42(38.2)
观察组	110	76(69.1)^a	71(64.5)^a	53(48.2)^a

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Application of external counterpulsation in the treatment of coronary atherosclerosis

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Application of external counterpulsation in the treatment of coronary atherosclerosis