雷射洞穿心肌血管新生術患者之短期效果評估報告

對於持續有症狀之末期冠狀動脈阻塞病患而無法以氣球擴張血管成型術(PTCA)或冠狀動脈繞道手術(CABG)來處理時，雷射洞穿心肌血管新生術(Transmyocardial Laser Revascularization; TMR)，以雷射在心肌打洞，以改善心肌缺血的現象的手術則是患者另一種治療方式。本文即是在評估接受雷射洞穿心肌血管新生術之患者其短期（3個月）心臟功能改善的療效。本研究共收集30位雷射洞穿心肌血管新生術病患，在術後約12週評估其心臟功能。評估是採用“美國心臟協會功能分類”及“穩定心絞痛分級”來比較術前術後之變化並記錄其藥物使用的情形。統計則是採用Wilcoxon signed rank test來分析。結果顯示在“功能分類”及“心絞痛分級”均有明顯的進步，但是心臟藥物的使用種類卻明顯增加。雷射洞穿心肌血管新生術雖能明顯短期減緩心絞痛的症狀，改善病患日常生活功能，但其長期療效仍有許多爭議，手術本身無論在短期或長期的追蹤均會產生少數的併發症，因此在進行心肺復健時，我們應特別注意其併發症發生的可能性，進而積極有效的處理，一方面改善病患心肺功能，提升生活品質，另一方面以避免不必要的醫療糾紛。

關鍵字

雷射洞穿心肌血管新生術；功能評估

並列摘要

Patients with symptomatic end-stage coronary artery disease, who had poor response to percutuneous transluminal coronary angioplaoty or coronary artery bypass grafting, the transmyocardial laser revascularization (TMR) seems to be an alternative method to relieve disabling ischemic symptoms. The purpose of this study was to evaluate the short-term results (about post-op 12 weeks) after TMR. Thirty patients were enrolled in the study. We used ”New York Heart Association functional classification” and ”stages of stable angina” to evaluate the functional changes after operation. The drug medicine was also reviewed. All functional evaluation showed significant improvement after TMR but increased in using cardiac drug was also noted. Although TMR has short-term improvement in angina and cardiac function, its long-term effect is still controversial. There were a few complications with TMR after short-term or long-term follow-up. When we performed comprehensive cardiopulmonary rehabilitation for those patients with TMR, we should be alert of the possibility of the complications to avoid legal problems.

並列關鍵字

transmyocardial laser revascularization ； functional evaluation

國際替代計量

雷射洞穿心肌血管新生術患者之短期效果評估報告

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