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Application of spinal cord electrical stimulation in the treatment of intractable angina pectoris

Angina pectoris is a clinical syndrome caused by acute, temporary ischemia and hypoxia of myocardium due to insufficient coronary blood supply. It is characterized by paroxysmal anterior chest crushing pain, which can be accompanied by other symptoms. The pain is mainly located at the back of the sternum and can radiate to the precordial area and left upper limb. It often occurs during labor or emotional excitement, lasts for several minutes, and disappears after rest or nitrate preparation. This disease is more common in men. Most patients are over 40 years old. Fatigue, emotional excitement, satiety, cold, rainy weather and acute circulatory failure are common inducements. In most patients with myocardial ischemia caused by coronary stenosis and exercise, angina pectoris can be improved by revascularization. Refractory angina pectoris refers to severe chronic chest pain caused by coronary heart disease, which can not be relieved by coronary artery bypass grafting, interventional surgery or drugs. With the development of surgical technology and drug treatment, the survival rate of patients with coronary heart disease has been significantly improved in the past few decades, which also increases the number of patients with refractory angina pectoris. The treatment of refractory angina pectoris has always been a difficulty in clinical and medical research. There are many therapeutic options in clinic, such as thoracic epidural injection, stellate ganglion blockade, enhanced external counterpulsation, percutaneous laser revascularization and percutaneous nerve stimulation As one of the important means of nerve regulation, spinal cord electrical stimulation (SCS) has attracted more and more attention in clinical application and scientific research because of its good safety and efficacy. Qiao Liang, Department of functional neurosurgery, Xuanwu Hospital, Capital Medical University

  1. Indications

Since the late 1960s, SCS has been applied to the treatment of a variety of chronic pain. In 1987, SCS was first reported in the world for the treatment of refractory angina pectoris. Since then, there have been a large number of relevant clinical cases, scientific research and review analysis. SCS has been recognized by the American College of Cardiology and American Heart Association Guidelines (class IIB) are recommended in the guidelines and (therapeutic alternative 1) is recommended by the European Society of Cardiology. Combined with literature analysis, angina pectoris cases treated with SCS should meet the “refractory” This principle is consistent with the diagnosis of angina pectoris and ineffective for routine drug and / or surgical treatment. A recent large-scale meta-analysis by Taylor suggests that SCS has similar efficacy and lower medical cost compared with traditional coronary artery bypass grafting and laser revascularization. Other similar studies suggest that SCS can choose drug and surgical refractory angina pectoris cases or patients Patients with angina pectoris who are unable or unwilling to undergo coronary artery bypass grafting or interventional surgery. In addition, patients undergoing SCS should have good psychological and cognitive abilities to smoothly cooperate with intraoperative and postoperative testing, evaluation and follow-up.

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