激光新技术治心绞痛
http://www.100md.com
2001年1月8日
路透社纽约健康消息-研究发现，试验性的激光治疗有助于减轻由心脏病引起的胸痛，尤其是那些不适宜进行动脉清扫治疗如旁路搭桥手术和冠脉成形术的心脏病患者。
这一激光新技术是现有跨心肌激光血管再造术(transmyocardial laser revascularization ，TMR)的改良。跨心肌激光血管再造术已获美国食品和药品管理局(FDA)批准，需要手术开胸，用一手持的激光钻出微小通道进入心脏肌层，以此提高心脏的血流量并减轻心脏病引起的胸痛，如心绞痛。新技术被称为经皮跨心肌激光血管再造术(percutaneous transmyocardial laser revascularization ，PTMR)，激光由导管传送的，导管则由动脉进入直达心脏。
根据《柳叶刀》11月18日的报导，在对221位心脏病人为期1年的研究中发现，经PTMR治疗的病人运动耐受力提高了，平均耐受力为89秒，而药物治疗的病人则不到13秒。激光治疗后，约有34%的患者的心绞痛得到改善，而未做该治疗的患者只有13%改善了心绞痛。
, 百拇医药
波士顿麻省总医院的史蒂芬· N ·奥斯特雷博士认为，尽管PTMR技术有明显的益处，但两组的生存率是相似的。PTMR组有8人死亡，而药物组为3人，两组的死亡率在统计学上没有显著差异。两组都有不少病人最后不得不进行血管成形术、旁路搭桥术或其他治疗。奥博士指出，与手术TMR比较，这种激光治疗手段损伤性较少，好处又差不多，而且副作用也比较少。但是他说这些研究结果还远不是结论性的。
因为出于伦理方面的考虑，研究者在研究中没有设安慰剂对照组。在安慰剂对照研究设计中，应该是一组病人进行PTMR，而另外一组则仅插入导管，但是没有在心脏上钻洞，而且参加者在研究完成之前不知道他们是否接受了激光治疗。奥博士认为，缺乏安慰剂组的对照将很难明确治疗益处的真实性。或者可能仅仅反映了健康状态差的人出于求生欲望使得治疗效果有所好转。他说PTMR虽然还未经FDA认可，但是是安全可行的，只是目前还不清楚这种治疗是否有效。
Laser Treatment May Relieve Severe Heart Pain<.b>
, 百拇医药
NEW YORK (Reuters Health) - An experimental laser treatment may help relieve heart disease-related chest pain in some people who are not good candidates for artery-clearing treatments like bypass surgery and angioplasty, study findings suggest.
The new technique is a variation of a laser procedure approved by the US Food and Drug Administration (news - web sites) (FDA), known as transmyocardial laser revascularization (TMR). In that technique, the chest is opened surgically and a hand-held laser is used to drill tiny channels into heart muscle, improving blood flow to the heart and relieving heart disease-related chest pain, known as angina.
, 百拇医药
In the new technique, called percutaneous transmyocardial laser revascularization (PTMR), the laser is delivered via a catheter, which is threaded through an artery until it reaches the heart.
In a 1-year study of 221 people with heart disease, exercise tolerance improved an average of 89 seconds in people who underwent PTMR compared with less than 13 seconds in those who were treated with drugs alone, according to the report in the November 18th issue of The Lancet. And angina improved in about 34% of people treated with the laser technique compared with just 13% of those who did not undergo the procedure.
, 百拇医药
But the results of the study are far from conclusive, the study‘s lead author told Reuters Health.
Despite the apparent benefits of PTMR, the survival rates were similar in both groups, said Dr. Stephen N. Oesterle, of Massachusetts General Hospital in Boston. Overall, 8 patients who underwent PTMR died, as did 3 in the drug-treatment group, although there was no statistical difference between the groups. A number of patients in both groups ended up needing angioplasty, bypass surgery or other treatment.
, 百拇医药
Compared with surgical TMR, the less invasive form of laser treatment provided similar benefits with fewer side effects, Oesterle told Reuters Health. But he said the results should be interpreted with caution.
Oesterle explained that, due to ethical considerations, the researchers decided not to include a placebo group in the study. In a placebo-controlled study, one group of patients would have undergone PTMR, while another would have had a catheter inserted, but no holes would have been made in the heart. The participants would not have known whether they had received the laser treatment until the study had been completed.
, 百拇医药
The lack of a placebo group makes it difficult to be certain that the benefits of the treatment were real, or if they simply reflected the desire of extremely unhealthy people to get better, Oesterle said. The study shows that PTMR, which has not been approved by the FDA, is safe and feasible, but it is not clear if the treatment is effective, according to the researcher., 百拇医药
这一激光新技术是现有跨心肌激光血管再造术(transmyocardial laser revascularization ，TMR)的改良。跨心肌激光血管再造术已获美国食品和药品管理局(FDA)批准，需要手术开胸，用一手持的激光钻出微小通道进入心脏肌层，以此提高心脏的血流量并减轻心脏病引起的胸痛，如心绞痛。新技术被称为经皮跨心肌激光血管再造术(percutaneous transmyocardial laser revascularization ，PTMR)，激光由导管传送的，导管则由动脉进入直达心脏。
根据《柳叶刀》11月18日的报导，在对221位心脏病人为期1年的研究中发现，经PTMR治疗的病人运动耐受力提高了，平均耐受力为89秒，而药物治疗的病人则不到13秒。激光治疗后，约有34%的患者的心绞痛得到改善，而未做该治疗的患者只有13%改善了心绞痛。
, 百拇医药
波士顿麻省总医院的史蒂芬· N ·奥斯特雷博士认为，尽管PTMR技术有明显的益处，但两组的生存率是相似的。PTMR组有8人死亡，而药物组为3人，两组的死亡率在统计学上没有显著差异。两组都有不少病人最后不得不进行血管成形术、旁路搭桥术或其他治疗。奥博士指出，与手术TMR比较，这种激光治疗手段损伤性较少，好处又差不多，而且副作用也比较少。但是他说这些研究结果还远不是结论性的。
因为出于伦理方面的考虑，研究者在研究中没有设安慰剂对照组。在安慰剂对照研究设计中，应该是一组病人进行PTMR，而另外一组则仅插入导管，但是没有在心脏上钻洞，而且参加者在研究完成之前不知道他们是否接受了激光治疗。奥博士认为，缺乏安慰剂组的对照将很难明确治疗益处的真实性。或者可能仅仅反映了健康状态差的人出于求生欲望使得治疗效果有所好转。他说PTMR虽然还未经FDA认可，但是是安全可行的，只是目前还不清楚这种治疗是否有效。
Laser Treatment May Relieve Severe Heart Pain<.b>
, 百拇医药
NEW YORK (Reuters Health) - An experimental laser treatment may help relieve heart disease-related chest pain in some people who are not good candidates for artery-clearing treatments like bypass surgery and angioplasty, study findings suggest.
The new technique is a variation of a laser procedure approved by the US Food and Drug Administration (news - web sites) (FDA), known as transmyocardial laser revascularization (TMR). In that technique, the chest is opened surgically and a hand-held laser is used to drill tiny channels into heart muscle, improving blood flow to the heart and relieving heart disease-related chest pain, known as angina.
, 百拇医药
In the new technique, called percutaneous transmyocardial laser revascularization (PTMR), the laser is delivered via a catheter, which is threaded through an artery until it reaches the heart.
In a 1-year study of 221 people with heart disease, exercise tolerance improved an average of 89 seconds in people who underwent PTMR compared with less than 13 seconds in those who were treated with drugs alone, according to the report in the November 18th issue of The Lancet. And angina improved in about 34% of people treated with the laser technique compared with just 13% of those who did not undergo the procedure.
, 百拇医药
But the results of the study are far from conclusive, the study‘s lead author told Reuters Health.
Despite the apparent benefits of PTMR, the survival rates were similar in both groups, said Dr. Stephen N. Oesterle, of Massachusetts General Hospital in Boston. Overall, 8 patients who underwent PTMR died, as did 3 in the drug-treatment group, although there was no statistical difference between the groups. A number of patients in both groups ended up needing angioplasty, bypass surgery or other treatment.
, 百拇医药
Compared with surgical TMR, the less invasive form of laser treatment provided similar benefits with fewer side effects, Oesterle told Reuters Health. But he said the results should be interpreted with caution.
Oesterle explained that, due to ethical considerations, the researchers decided not to include a placebo group in the study. In a placebo-controlled study, one group of patients would have undergone PTMR, while another would have had a catheter inserted, but no holes would have been made in the heart. The participants would not have known whether they had received the laser treatment until the study had been completed.
, 百拇医药
The lack of a placebo group makes it difficult to be certain that the benefits of the treatment were real, or if they simply reflected the desire of extremely unhealthy people to get better, Oesterle said. The study shows that PTMR, which has not been approved by the FDA, is safe and feasible, but it is not clear if the treatment is effective, according to the researcher., 百拇医药