本邦発の体外式動脈カウンターパルセーション補助循環システム(コンパクトCP)を臨床応用した再発性狭心症の1例

A Novel Japanese External Counterpulsation Circulatory Assist System(Compact CP): Clinical application to a patient with recurrent angina

要旨　小型化，予圧の採用による衝撃の軽減，騒音の軽減，2：1モードの導入，4つのカフの間に時間差をつけて加圧するなど，様々な改良を加えた本邦発の体外式動脈カウンターパルセーション(ECP)システムを開発し，65歳の冠動脈バイパス術後遠隔期再発性狭心症の男性患者に臨床応用した．患者は，ECP前は多様な内服薬投与にもかかわらず1日2～3回の胸痛が出現し，平均週5錠のニトログリセリン舌下投与が必要であった．1回1時間，7週間，計35回のECPを行い，通院実施に切り替えた2週目に2回ニトログリセリン舌下を要したのを最後に胸痛自体消失し，ECP終了後2カ月以上経過後も軽快が持続している．ECPの効果発現機序には未解明の点もあるうえ，本患者は負荷テストでの明瞭な改善がなく今後の経過に注意を要するが，本ECPシステムは，特に血行再建治療の適応になりにくい虚血性心疾患患者に対する有用な治療手段として期待しうる．

　A domestic external counterpulsation circulatory assist system with several innovations(smaller controller, minimized shock to patients' body with constant cuff pressure, reduced noise, adoption of 2: 1 mode, delayed inflation to 4 cuff segments, and so forth) has been newly devised. It was clinically applied to a 65 year-old male patient with recurrent angina late after coronary artery bypass surgery. Despite maximal medical therapy, he had been using oral nitroglycerin tablets 5 times a week on the average. He underwent 35 ECP sessions(1 hour each, for 7 weeks). He used nitroglycerin twice in the second week when he began to undergo ECP as an outpatient. Thereafter, he had become free from chest discomfort, and he is still asymptomatic even 2 months after he has completed 35 ECP sessions. In contrast to such drastic remission in clinical symptoms, results of stress tests did not show marked change after ECP sessions. Moreover, some aspects of ECP have not yet been fully elucidated. This patient, therefore, requires close follow-up. However, this novel domestic ECP system can be an effective treatment modality especially for those who have ischemic heart disease and are not good candidates for revascularization therapy.