心区交感神经阻滞对扩张型心肌病严重心力衰竭疗效观察

Effect of cardiac sympathetic blockade on severe heart failure in patients with dilated cardiomyopathy

目的观察心区交感神经阻滞对扩张型心肌病严重心力衰竭患者心脏功能的影响。方法随机选取扩张型心肌病严重心力衰竭患者39名,分为对照组和治疗组。对照组给予常规治疗,治疗组在常规治疗的同时进行心区交感神经阻滞(胸1-5),0.5%利多卡因每2小时经胸段硬膜外导管推注1次(除夜间睡眠外)。所有患者于治疗前和治疗后1个月进行心脏彩超检查,测量左心室射血分数(EF),短轴缩短率(FS),二尖瓣关闭时间和左心室射血时间,计算心肌功能指数(MPI),比较治疗前后心功能分级和上述指标的变化。结果治疗后对照组与治疗组的心功能分级均明显改善,但治疗组心功能分级好于对照组(2.13±0.63,2.88±0.62,P< 0.01);治疗后治疗组心功能分级差值明显大于对照组(1.74±0.54,1.06±0.68,P< 0.05);与治疗前比较,治疗后治疗组左心室射血时间、EF和FS均显著增加,MPI明显降低(0.71±0.23,0.55±0.35,P< 0.05),而对照组上述指标均无显著变化。结论心区交感神经阻滞能显著改善扩张型心肌病严重心力衰竭患者,左心室功能;对心功能分级改善的程度优于常规治疗。

Objective To investigate the effect of cardiac sympathetic blockade on cardiac performance in patients with dilated cardiomyopathy and severe heart failure. Methods Thirty nine patients with dilated cardiomyopathy and severe heart failure were randomly selected and divided into control group and therapy group. Routine treatment was adopted in control group. In therapy group, in addition to routine treatment, cardiac sympathetic blockade was given at the same time by intermittent injection of 0.5% lidocaine per 2 hours through thoracic epidural catheter except for the night. All the patients received routine transthoracic echocardiography before and one month after treatment. Left ventricular ejection fraction(EF), fractional shortening(FS), mitral valve closing time and left ventricular ejection time were measured and myocardial performance index (MPI) was calculated. Cardiac functional class and the above parameters were compared between the two groups. Results After treatment, cardiac functional class was improved both in control and therapy group. While in therapy group, cardiac functional class was better(2.13±0.63, 2.88±0.62, P < 0.01) and cardiac functional class difference was bigger than that of control group(1.74±0.54, 1.06±0.68, P < 0.05). After treatment, left ventricular ejection time, EF and FS were significantly increased, MPI was decreased significantly(0.71±0.23, 0.55±0.35, P < 0.05) in therapy group, while those parameters did not change significantly in control group. Conclusions As to patients with dilated cardiomyopathy and severe heart failure, cardiac sympathetic blockade can significangly improve left ventricular global funtion. The extent of cardiac functional class improvement was more significant than that of routine treatment.