增强型体外反搏治疗心肾综合征IV期一例并文献复习

Enhanced External Counterpulsation Therapy Cardiorenal for Syndrome Type IV: A Case Report and Literature Review

摘要: 目的：评估长期增强型体外反搏(Enhanced External Counterpulsation, EECP)在心肾综合征(Cardiorenal syndrome, CRS)患者中的疗效。方法：报道1例52岁男性CRS患者，冠脉支架植入术后反复胸闷、胸痛，接受多次EECP治疗的诊治经过及临床资料。以“EECP”和“肾功能不全”为关键词，在CNKI和PubMed数据库中进行文献检索。结果：患者有劳力性胸痛病史1年，硝酸甘油可缓解，合并慢性肾衰竭尿毒症病史8年，规律血液透析治疗。冠脉CTA显示三支病变。2023年10月行CAG + PCI术，植入Firehawk支架。2024年3月复查CAG提示支架内再狭窄，分别于2024-03-26、2024-08-27行PTCA术，入院1周前再次出现胸闷、胸痛，应用硝酸甘油部分缓解。在常规治疗基础上加用EECP，患者活动耐量提高，胸闷、胸痛发作频率减少。随访期间血压稳定于140/90 mmHg，体重维持在79 kg，未发生心脏不良事件，日常活动不受限。结论：EECP作为常规治疗的辅助手段，可有效改善CRS患者的症状及预后。

Abstract: Objective: To evaluate the efficacy of long-term enhanced external counterpulsation (EECP) in patients with cardiorenal syndrome (CRS). Methods: A 52-year-old male CRS patient with repeated chest tightness and chest pain after coronary stent implantation was reported, and the diagnosis, treatment and clinical data were reported. Taking “EECP” and “renal insufficiency” as keywords, the literature was searched in CNKI and PubMed databases. Results: The patient had a history of exertional chest pain for 1 year, and nitroglycerin could be relieved. He had a history of uremia complicated with chronic renal failure for 8 years, and he was treated with regular hemodialysis. Coronary CTA showed three lesions. In October 2023, CAG + PCI was performed and Firehawk stent was implanted. In March 2024, CAG reexamination revealed restenosis in stent. PTCA was performed on March 26th, 2024 and August 27th, 2024, respectively. Chest tightness and chest pain occurred again one week before admission, which was partially relieved by nitroglycerin. On the basis of routine treatment, EECP can improve the patient’s activity tolerance and reduce the frequency of chest tightness and chest pain. During the follow-up period, the blood pressure was stable at 140/90 mmHg, the weight was maintained at 79 kg, no adverse cardiac events occurred, and daily activities were not restricted. Conclusion: EECP, as an auxiliary means of routine treatment, can effectively improve the symptoms and prognosis of CRS patients.