心阻抗图评估增强型体外反搏治疗冠心病疗效的临床研究

Clinical Study on Efficacy Evaluation of Enhanced External Counterpulsation in the Treatment of Coronary Heart Disease by Impedance Cardiography

摘要: 目的：本研究旨在探讨心阻抗图(ICG)评估增强型体外反搏(EECP)治疗冠心病的临床价值，明确EECP对心脏泵功能及负荷的影响，验证ICG作为无创评估手段的可行性。方法：选取2023年12月~2024年7月青岛大学附属医院心血管内科收治的冠心病患者352例，采用随机数字表法分为对照组与试验组，每组176例。对照组给予常规药物治疗；试验组在药物基础上联合EECP干预。分别于治疗前后采用ICG检测SV、CO、CI、SVRI、LVEDP；同时行6分钟步行试验，记录步行距离、运动后即刻心率及Borg疲劳评分。主要结局指标为CI变化，次要结局指标包括SV、CO、SVRI、LVEDP及6MWT相关指标。采用SPSS 27.0进行统计学分析。结果：研究期间共失访80例，最终试验组150例、对照组122例纳入统计。(1) 基线特征：两组基线年龄、性别、BMI、高血压及糖尿病病史比例、基线ICG指标、6MWT指标均无统计学差异(均P > 0.05)，基线均衡可比。(2) 主要结局指标变化：治疗后，两组CI均显著升高(均P < 0.001)，试验组CI净增(0.642 ± 0.378) L/min/m²，显著高于对照组(0.221 ± 0.299) L/min/m² (P < 0.001)。(3) 次要结局指标变化：治疗后，试验组SV、CO升高幅度，SVRI、LVEDP下降幅度均显著优于对照组(均P < 0.001)。6MWT结果显示，试验组步行距离净增显著高于对照组；Borg疲劳评分、运动后即刻心率下降幅度亦显著优于对照组(均P < 0.01)。(4) 指标相关性：Pearson相关性分析显示，CI改善与SV、CO升高呈强正相关，与SVRI、LVEDP下降呈负相关；6MWT距离改善与CI、SV、CO升高及SVRI下降呈显著相关。结论：常规药物联合EECP可显著改善冠心病患者心脏泵血功能、降低外周血管阻力与左心室舒张负荷，提升运动耐量，疗效显著优于单纯药物治疗。心阻抗图可无创、实时、定量监测EECP治疗前后血流动力学变化，指标稳定、相关性强，可作为评估EECP治疗冠心病疗效的可靠辅助监测工具，具有重要临床推广价值。

Abstract: Objective: This study aimed to investigate the clinical value of impedance cardiography (ICG) in evaluating the efficacy of enhanced external counterpulsation (EECP) in the treatment of coronary heart disease (CHD), to clarify the effects of EECP on cardiac pump function and cardiac load, and to verify the feasibility of ICG as a non-invasive assessment tool. Methods: From December 2023 to July 2024, 352 patients with coronary heart disease admitted to the Department of Cardiology, The Affiliated Hospital of Qingdao University were enrolled and randomly assigned to control and experimental groups, with 176 cases in each group. The control group received conventional drug therapy, while the experimental group was treated with EECP in addition to routine medication. Before and after treatment, SV, CO, CI, SVRI and LVEDP were detected by ICG, and the 6-minute walk test was conducted to record walking distance, immediate post-exercise heart rate and Borg fatigue score. The primary outcome was the change in CI, and secondary outcomes included SV, CO, SVRI, LVEDP and 6MWT-related indicators. Statistical analysis was performed using SPSS 27.0. Results: A total of 80 patients were lost to follow-up during the study. Finally, 150 patients in the experimental group and 122 patients in the control group were included in the statistical analysis. (1) Baseline characteristics: There were no statistically significant differences between the two groups in age, gender, BMI, proportions of hypertension and diabetes history, baseline ICG parameters, or 6MWT indicators (all P > 0.05), indicating balanced and comparable baselines. (2) Changes in primary outcome: After treatment, CI increased significantly in both groups (all P < 0.001). The net increase in CI in the experimental group was (0.642 ± 0.378) L/min/m², which was significantly higher than (0.221 ± 0.299) L/min/m² in the control group (P < 0.001). (3) Changes in secondary outcomes: After treatment, the experimental group showed significantly greater increases in SV and CO, as well as greater decreases in SVRI and LVEDP, compared with the control group (all P < 0.001). The 6MWT results revealed that the net increase in walking distance in the experimental group was significantly higher than that in the control group; the reductions in Borg fatigue score and immediate postexercise heart rate were also significantly superior in the experimental group (all P < 0.01). (4) Correlation of indicators: Pearson correlation analysis showed that the improvement in CI was strongly positively correlated with increases in SV and CO, and negatively correlated with decreases in SVRI and LVEDP. The improvement in 6MWT distance was significantly correlated with increases in CI, SV, CO and the decrease in SVRI. Conclusions: Conventional medication combined with EECP can significantly improve cardiac pumping function, reduce peripheral vascular resistance and left ventricular diastolic load, and enhance exercise tolerance in patients with coronary heart disease, and the efficacy is significantly better than that of conventional medication alone. Impedance cardiography enables non-invasive, real-time and quantitative monitoring of hemodynamic changes before and after EECP treatment, with stable indicators and strong correlations. It can be used as a reliable monitoring tool for evaluating the therapeutic effect of EECP on coronary heart disease and has important clinical promotion value.