Jessurun G A J, Hautvast R W M, Tio R A, DeJongste M J L
Department of Cardiology, University Hospital Groningen, Thoraxcenter, Hanzeplein 1, Postbus 30001, 9700 RB Groningen, The Netherlands.
Eur J Pain. 2003;7(6):507-12. doi: 10.1016/S1090-3801(03)00022-3.
At present, there is no reliable antianginal drug therapy for patients with cardiac syndrome X. Therefore, the effect of electrical neuromodulation on refractory angina pectoris and myocardial perfusion in cardiac syndrome X was assessed. Eight patients (aged 55+/-7 years) with heterogeneous myocardial perfusion and no esophageal abnormalities were included. The subjects were nonresponders to antianginal drug therapy. Angina pectoris attacks and myocardial perfusion dynamics were evaluated by positron emission tomography at baseline and following 4 weeks of (transcutaneous electrical nerve stimulation) TENS. Following TENS there was a reduction of angina pectoris episodes (baseline 20+/-3, TENS 3+/-1; p=0.012), and short acting nitroglycerin intake per week (baseline 10+/-3, TENS 2+/-1; p=0.008). The rate pressure product (mmHg min(-1)) during the cold pressor test (CPT) was reduced during TENS (baseline 12800+/-1200, TENS 11500+/-900; p=0.02). Following TENS, the perfusion reserve ratio between rest and dipyridamole flow increased (baseline 1.59+/-0.15, TENS 1.90+/-0.11 ml min(-1)x 100g; p=0.05). The coronary vascular resistance had a trend towards a reduction (baseline 0.96+/-0.04, TENS 0.85+/-0.06 mmHg min(-1)x 100 g/ml; p=0.06) during CPT. This observation may suggest that neurostimulation improves angina pectoris with a concomitant improvement of myocardial perfusion in cardiac syndrome X.
目前，对于心脏X综合征患者尚无可靠的抗心绞痛药物治疗方法。因此，评估了电神经调节对心脏X综合征难治性心绞痛和心肌灌注的影响。纳入了8例（年龄55±7岁）心肌灌注不均一且无食管异常的患者。这些受试者对抗心绞痛药物治疗无反应。在基线时以及经皮电神经刺激（TENS）4周后，通过正电子发射断层扫描评估心绞痛发作情况和心肌灌注动力学。TENS治疗后，心绞痛发作次数减少（基线时20±3次，TENS治疗后3±1次；p = 0.012），每周短效硝酸甘油摄入量减少（基线时10±3次，TENS治疗后2±1次；p = 0.008）。在TENS期间，冷加压试验（CPT）期间的心率血压乘积（mmHg·min⁻¹）降低（基线时12800±1200，TENS治疗后11500±900；p = 0.02）。TENS治疗后，静息与双嘧达莫血流之间的灌注储备率增加（基线时1.59±0.15，TENS治疗后1.90±0.11 ml·min⁻¹×100g；p = 0.05）。在CPT期间，冠状动脉血管阻力有降低趋势（基线时0.96±0.04，TENS治疗后0.85±0.06 mmHg·min⁻¹×100 g/ml；p = 0.06）。这一观察结果可能表明，神经刺激可改善心脏X综合征患者的心绞痛，并伴随心肌灌注的改善。
