雷射洞穿心肌血管新生術患者之運動心肺功能評估

對於冠狀動脈阻塞無法做氣球擴張血管成型術或冠狀動脈繞道手術之患者，雷射洞穿心肌血管新生術(transmyocardial laser revascularization)，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此手術之患者，其術後運動心肺功能的狀況。共有10名患者參與本研究，結果顯示所有患者，其原有肺功能是不受手術影響，有氧運動能力雖達5METs左右，足敷日常生活所須，但從無氣呼吸閥值及有氧性功能缺損率而言，其有氧運動能力仍屬偏低。整體評估結論中，正常的有1人（佔10%），不正常有5人（佔50%），未有結論的有4人（佔40%），且整個測試過程中，7人有心率反應不良(chronotropic incompetence),4人有血壓反應不足，2人有左心室功能下降的現象，這顯示接受雷射洞穿心肌血管新生術患者術後有高比率的左心室功能障礙。因此對於接受雷射洞穿心肌血管新生術患者而言，心肺復健是有其必要性的；藉著整體性的心肺復健計畫，可改善其有氧運動能力，增進日常生活功能。

關鍵字

雷射洞穿心肌血管新生術；運動心肺功能測試

並列摘要

For patients with symptomatic end-stage coronary artery disease, who have had a poor response to percutaneous transluminal coronary angioplasty or coronary artery bypass grafting, transmyocardial revascularization (TMR) seems to be an alternative to relieve disabling ischemic symptoms. The purpose of this study was to evaluate, by cardiopulmonary exercise testing, the cardiopulmonary capacity after TMR. Ten patients were enrolled in the study. None of them showed significant exacerbation in pulmonary function after TMR. Their average aerobic capacity was about 5MET5; a lower anaerobic threshold and high functional aerobic impairment revealed an insufficient cardiopulmonary capacity. The result of testing showed 1 normal(10%),5 abnormal(50%) and 4 inconclusive(40%). Of the 10 patients during testing, 7 had chronotropic incompetence, 4 had inadequate BP response, and 2 had decreased left ventricular function. There was a higher incidence of left ventricular dysfunction in patients with TMR. Results revealed the importance of a comprehensive cardiopulmonary rehabilitation program for patents with TMR, for the improvement of cardiopulmonary and ADL functions.

並列關鍵字

transmyocardial laser revascularization ； cardiopulmonary exercise testing

國際替代計量

雷射洞穿心肌血管新生術患者之運動心肺功能評估

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