Expert consensus on the quality control management and clinical efficacy evaluation of enhanced external counterpulsation
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摘要: 增强型体外反搏(enhanced external counterpulsation，EECP，简称“体外反搏”)于20世纪80年代初成功应用于临床并相继推广到全球36个国家和地区，在慢性心脑缺血性疾病治疗和康复中发挥了重要作用，并被欧美和中国的13个临床指南和专家共识纳入推荐。由于国内外体外反搏大规模随机对照研究的数据不多，指南推荐级别还不高，随着体外反搏在心血管疾病治疗和脏器康复中的作用地位逐渐提升，开展体外反搏的机构日益增多，迫切需要对体外反搏技术的应用进行规范，并对其临床疗效作科学的评估。本专家共识基于体外反搏应用的临床需求，在体外反搏适应证选择、质量控制方法以及疗效评估手段等方面作了重点阐述，为从事体外反搏技术临床应用的医务工作者提供专业技术指导与应用规范参考。Abstract: Since its successful application in clinical practice in the 1980s, enhanced external counterpulsation(EECP) has been gradually extended to 36 countries and regions worldwide. Today, EECP has been recommended in 13 international guidelines and expert consensus documents for the treatment and rehabilitation of ischemic diseases such as coronary artery disease, angina, and stroke. With the rapid promotion and practice of cardiac rehabilitation concepts, the status of EECP in the treatment of cardiovascular diseases and organ rehabilitation are gradually rising. The present expert consensus systematically reviewed relevant literatures both domestically and internationally, and formulated corresponding recommendations including indications, quality control and management, clinical evaluations of EECP treatment, in order to promote standardized application and scientific management in the field of EECP technology to maximize the therapeutic benefits of EECP treatment.
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图 1 体外反搏前和体外反搏中的脉搏波示意图
Figure 1. Diagram of pulse waves before and during external counterpulsation
表 1 推荐强度说明
Table 1. Classes of recommendations
推荐依据 建议描述 建议标识 基于广泛临床应用实践或至少一项RCT研究证据支持 强力推荐 +++ 基于临床实践经验获得专家一致性推荐意见的支持 一般推荐 ++ 有临床应用但未获专家一致性推荐意见 弱推荐 + 注：RCT为随机对照试验。 
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表 2 体外反搏治疗质控管理与疗效评估方法的推荐级别概览
Table 2. Evaluation methods and recommendation levels
评估方法 推荐级别 指脉波D/S比值 +++ 标准心电图 +++ 动态心电图 +++ 心脏超声多普勒检查 +++ 6 MWT +++ EET +++ CPET +++ FMD +++ 反映外周动脉血管功能的PWV、Aix及ABI等指标 +++ 基于胸阻抗法的无创心血管功能检测 ++ CNAP + 放射性核素心肌显像 +++ 冠脉血流储备检测(有创/无创) + 脑卒中临床量表 ++ 基于CT/MR扫描的脑灌注评估 ++ TCD +++ 生活质量评估(含睡眠质量评估) +++
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