脊髓刺激对心肌缺血和心率变异性的长期影响：48小时动态心电图监测结果

Long-term effects of spinal cord stimulation on myocardial ischemia and heart rate variability: results of a 48-hour ambulatory electrocardiographic monitoring.

作者信息

Di Pede F, Zuin G, Giada F, Pinato G, Turiano G, Bevilacqua M, Cazzin R, Raviele A

机构信息

Cardiology Department, Umberto I Hospital, Mestre-Venice, Italy.

出版信息

Ital Heart J. 2001 Sep;2(9):690-5.

PMID:11666098

Abstract

BACKGROUND

Spinal cord stimulation (SCS) has analgesic properties and may be used to treat pain in patients with therapeutically refractory angina who are unsuitable for myocardial revascularization. Some studies have also demonstrated an anti-ischemic effect. The aim of this study was to evaluate the long-term persistence of the effects of SCS on myocardial ischemia and on heart rate variability.

METHODS

Fifteen patients (9 males, 6 females, mean age 76 +/- 8 years, range 58-90 years) with severe refractory angina pectoris (Canadian class III-IV), on optimal pharmacological therapy, unsuitable for myocardial revascularization and treated with SCS for a mean follow-up of 39 +/- 27 months (range 9-92 months) were studied. Eleven patients had had a previous myocardial infarction and 5 a coronary artery bypass graft. The mean ejection fraction was 54 +/- 7% (range 36-65%). All patients underwent 48-hour ambulatory ECG monitoring and were randomly assigned to 24 hours without SCS (off period) and 24 hours with SCS (on period). The primary endpoints were: number of ischemic episodes, total duration of ischemic episodes (min), and total ischemic burden (mV*min).

RESULTS

The heart rate was not statistically different during the off and on SCS periods (median 64 and 67 b/min respectively). The number of ischemic episodes decreased from a median of 6 (range 0-29) during the off period to 3 (range 0-24) during the on period (p < 0.05). The total duration of ischemic episodes decreased from a median of 29 min (range 0- 186 min) during the off period to 16 min (range 0-123 min) during the on period (p < 0.05). The total ischemic burden decreased from a median of 2.5 mVmin (range 0-19.5 mVmin) during the off period to 0.8 mVmin (range 0-13 mVmin) during the on period (p = NS). The heart rate variability parameters were similar during the on and off periods.

CONCLUSIONS

SCS exerts long-term anti-ischemic effects.

摘要

背景

脊髓刺激（SCS）具有镇痛作用，可用于治疗不适宜进行心肌血运重建的难治性心绞痛患者的疼痛。一些研究还证实了其抗缺血作用。本研究的目的是评估SCS对心肌缺血和心率变异性影响的长期持续性。

方法

对15例患者（9例男性，6例女性，平均年龄76±8岁，范围58 - 90岁）进行研究，这些患者患有严重难治性心绞痛（加拿大心血管学会分级III - IV级），接受了最佳药物治疗，不适宜进行心肌血运重建，并接受了SCS治疗，平均随访时间为39±27个月（范围9 - 92个月）。11例患者曾有过心肌梗死，5例接受过冠状动脉搭桥术。平均射血分数为54±7%（范围36 - 65%）。所有患者均接受了48小时动态心电图监测，并被随机分为无SCS的24小时（关期）和有SCS的24小时（开期）。主要终点指标为：缺血发作次数、缺血发作总时长（分钟）和总缺血负荷（mV·分钟）。

结果

SCS关期和开期的心率无统计学差异（中位数分别为64次/分钟和67次/分钟）。缺血发作次数从关期的中位数6次（范围0 - 29次）降至开期的3次（范围0 - 24次）（p < 0.05）。缺血发作总时长从关期的中位数29分钟（范围0 - 186分钟）降至开期的16分钟（范围0 - 123分钟）（p < 0.05）。总缺血负荷从关期的中位数2.5 mV·分钟（范围0 - 19.5 mV·分钟）降至开期的0.8 mV·分钟（范围0 - 13 mV·分钟）（p =无统计学意义）。开期和关期的心率变异性参数相似。