Braverman Debra L
Albert Einstein Medical Center, Philadelphia, PA 19111, USA.
PM R. 2009 Mar;1(3):268-76. doi: 10.1016/j.pmrj.2008.12.002.
The prevalence of refractory angina in the United States is 600,000 to 1.8 million. Improved pharmacological, invasive, and surgical therapies for cardiovascular diseases during the last few decades have led to an increase in life expectancy of such individuals. Despite treatment with multiple medications and invasive procedures, these patients remain symptomatic and functionally limited. Enhanced external counterpulsation (EECP) is a safe, noninvasive, well-tolerated, and clinically effective outpatient physical therapy for many patients with refractory angina. Numerous trials demonstrate positive clinical responses among at least 80% of patients undergoing EECP, including reductions in angina and nitrate use, increases in exercise tolerance, and enhanced quality of life. Several mechanisms, including the promotion of collateral blood flow, improvement in endothelial function, reduction in inflammation, and the production of peripheral training effects similar to exercise, are thought to be responsible for the clinical benefits of this therapy. Despite the marked success rates EECP achieves with appropriately selected patients who have end-stage coronary artery disease, the treatment remains largely unknown, particularly among physiatrists. This review will summarize the current evidence for the use of EECP and spark a better understanding of the potential role of this treatment in cardiac rehabilitation.
在美国，顽固性心绞痛的患病率为60万至180万。在过去几十年中，心血管疾病的药物治疗、侵入性治疗和手术治疗得到改进，使得这类患者的预期寿命有所延长。尽管接受了多种药物治疗和侵入性手术，但这些患者仍有症状且功能受限。增强型体外反搏（EECP）对于许多顽固性心绞痛患者来说，是一种安全、无创、耐受性良好且临床有效的门诊物理治疗方法。大量试验表明，至少80%接受EECP治疗的患者有积极的临床反应，包括心绞痛减轻、硝酸酯类药物使用减少、运动耐量增加以及生活质量提高。这种治疗产生临床益处的机制有多种，包括促进侧支血流、改善内皮功能、减轻炎症以及产生类似于运动的外周训练效果。尽管EECP在适当选择的终末期冠状动脉疾病患者中取得了显著的成功率，但这种治疗方法在很大程度上仍不为人所知，尤其是在物理治疗师中。本综述将总结目前使用EECP的证据，并促使人们更好地理解这种治疗方法在心脏康复中的潜在作用。
