一位經全吸收式心臟支架放置術後之進行性冠狀動脈心臟病患者的物理治療介入過程－個案報告

Introduction of Bioresorbable Vascular Scaffold and Physical Therapy Intervention in Patient with Progressed Coronary Artery Disease - A Case Report

邱元駿(Yuan-Chun Chiu) ； 蕭淑芳(Shu-Fang Hsiao)

《物理治療》 42卷2期 (2017/06) Pp. 106-114

https://doi.org/10.6215/FJPT.PTS20170642027

摘要

心臟支架放置術是冠狀動脈疾病治療方式之一；塗藥支架（drug-eluting stent, DES）因比傳統支架（bare-metal stent, BMS）更可以降低冠狀動脈的再狹窄率，因此成為目前支架裝置種類的主流，然而塗藥支架仍因其本身屬於外來物，隨放置時間增加，進而造成身體血管內皮細胞發炎的機會，導致血管之再狹窄，因此，近年來發展出「全吸收式心臟支架（bioresorbable vascular scaffold, BVS）」，藉由可吸收的材質來解決上述的問題。本文使用「個案處理模式」與「國際健康功能與身心障礙分類系統」進行分析。個案是一名45歲男性，因感到胸悶以及用力呼吸困難；在4月28日接受冠狀動脈攝影與電腦斷層掃描顯示有冠狀動脈疾病，在左前降枝與左迴旋枝，分別有80%和90%狹窄。於是進行經皮氣球擴張冠狀動脈支架成形術（分別使用傳統支架、塗藥支架、全吸收式支架各一）。在出院後第四週開始接受第二期心臟復健計畫。物理治療計劃以心跳儲存量之70%作為訓練強度，希望能改善個案運動耐受力，促進生活品質。經過3個月的治療，個案之最大攝氧量由1,740 ml/min（6.7 METs）增為2,267 ml/min（8.9 METs）。但隨著時間進展，在訓練期間發現其心臟缺血閾值與胸口不適的症狀在較低運動強度時就產生，因此暫停物理治療訓練，建議回心臟內科門診追蹤。2015年9月16日心導管顯示原先之支架內並無狹窄，但左迴旋枝之近端及開口有新的狹窄，因此再放置兩支支架。此篇主要提供介入時進行性心臟疾病的處理過程以及新式心臟支架的相關知識，藉此提供臨床物理治療重要的參考資訊。

關鍵字

全吸收式心臟支架 ； 冠狀動脈心臟病 ； 心臟復健 ； 物理治療

並列摘要

Plain old balloon angioplasty with stent (POBAS) is one of the treatments for coronary artery disease (CAD). Drug-eluting stent (DES) is the mainstream of the stent types because it reduces the incidence of restenosis, as compared with bare-metal stent (BMS). However, DES is still regarded as foreign objects on the body, which increases the probability to damage on vascular endothelial cells over time and causes stenosis of the blood vessels again. Therefore, in recent years, the bioresorbable vascular scaffold (BVS) has been developed, which may solve the above problems by the absorbable material. This article reported a case by using the Client Management Model and international classifica-tion of functioning, disability and health. The case is a 45-year-old man diagnosed with CAD. He suffered from chest tightness and dyspnea on exertion for months. On 4/28/2015, the coronary angi-ography and computer tomography revealed coronary atherosclerosis which were 80% stenosis in left anterior descending branch and 90% stenosis in left circumflex branch (LCX), then POBAS was performed (1 BMS, 1 DES and 1 BVS, respectively). Cardiac rehabilitation phase II program was started in the fourth week after discharge. The treatment goals of physical therapy programs were to improve his endurance and the quality of life. The intensity of exercise program is approximately 70% of heart rate reserve. After two-month physical therapy, the patient's maximal oxygen consumption increased from 1740 ml/min (6.7 METs) to 2,267 ml/min (8.9 METs), but the threshold of cardiac ischemia and chest discomfort started to appear at lower intensity training since 8/24/2015. Therefore, we stopped exercise training and advised him to return the outpatient department of cardiologist. On 9/16/2015, Cardiac catheterization showed no in-stent restenosis in original stents, but 85% stenosis in the proximal-LCX. Two new stents were placed in LCX. This case report mainly provides interventional procedures in progressive heart disease and the information about new heart stent, which offers an important suggestion for clinical physical therapy.

並列關鍵字

Bioresorbable vascular scaffold ； Coronary artery disease ； Cardiac rehabilitation ； Physical therapy