Rapati D, Capucci R, Berti M, Danelli G, Torri G, Alfieri O
Servizio di Anestesia e Rianimazione, Istituto Scientifico Ospedale S. Raffaele, Milan, Italy.
Minerva Anestesiol. 2001 Nov;67(11):803-10.
Spinal cord stimulation (SCS) is a treatment that exploits the antalgic and vasodilatory effects on the microcirculation produced by a stimulating electrode positioned in the peridural space. This therapy has been used for years in the treatment of refractory angina pectoris. The aim of this study was to monitor the clinical effectiveness of the technique in terms of symptomatic benefits and, above all, improved quality of life in angina patients undergoing SCS.
From November 1998 to December 2000 we used SCS to treat 17 patients with refractory angina (functional class III or IV Canadian Cardiovascular Society) with onset more than one year earlier. All patients had undergone one or more traditional revascularisation procedures and were receiving maximum drug therapy. Patients were assigned to SCS because it was not technically possible to perform other revascularisation procedures. Quality of life was measured before and after treatment using a multidimensional index (QL Spitzer's index). We also noted the mortality, acceptance and morbidity of the procedure during a follow-up lasting 10 months on average. Lastly, the number of weekly anginal pain attacks, weekly nitrate consumption and CCS functional class were recorded before treatment and 1, 3 and six months after therapy.
SPC was effective in 13 patients out of 17 (76.47%). In responders the quality of life improved by 70%: in these patients, the number of weekly angina attacks reduced from 11.76+/-7.56 to 2.14+/-2.54, and the functional class from 3.30+/-0.75 to 1.5+/-0.53. No major periprocedural complications were reported. The annual mortality rate was 6.6%. The technique was easy to use.
The results of this study show that SCS is effective, safe, easy to use and well tolerated by patients with refractory angina who fail to respond to traditional revascularisation. This technique substantially improves the quality of life of patients suffering from refractory angina.
脊髓刺激（SCS）是一种利用置于硬膜外腔的刺激电极对微循环产生的镇痛和血管舒张作用的治疗方法。这种疗法多年来一直用于治疗顽固性心绞痛。本研究的目的是监测该技术在症状改善方面的临床效果，尤其是对接受SCS治疗的心绞痛患者生活质量的改善情况。
从1998年11月至2000年12月，我们使用SCS治疗了17例顽固性心绞痛患者（加拿大心血管学会功能分级为III或IV级），发病时间超过一年。所有患者均接受了一次或多次传统血管重建手术，并接受了最大剂量的药物治疗。患者因技术上无法进行其他血管重建手术而被分配接受SCS治疗。使用多维指数（QL Spitzer指数）在治疗前后测量生活质量。我们还记录了平均为期10个月的随访期间该手术的死亡率、接受率和发病率。最后，记录治疗前以及治疗后1、3和6个月时每周心绞痛发作次数、每周硝酸酯类药物消耗量和CCS功能分级。
17例患者中有13例（76.47%）SPC治疗有效。在有反应的患者中，生活质量提高了70%：在这些患者中，每周心绞痛发作次数从11.76±7.56次减少到2.14±2.54次，功能分级从3.30±0.75级降至1.5±0.53级。未报告重大围手术期并发症。年死亡率为6.6%。该技术易于使用。
本研究结果表明，SCS对传统血管重建治疗无效的顽固性心绞痛患者有效、安全、易于使用且耐受性良好。该技术显著改善了顽固性心绞痛患者的生活质量。
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