局部阻滞肾神经治疗心力衰竭的临床应用

Effects of regional nerve blockade in patients with heart failure

目的观察局部阻滞肾神经治疗充血性心力衰竭（心衰）的临床疗效和可行性。方法选择10例慢性充血性心衰患者。入选标准：心功能分级达Ⅲ一Ⅳ级并伴有难治性容量负荷过重，排除伴有糖尿病或肾功能不全。10例患者年龄在55～75岁，平均64±11岁，男性8例，女性2例。其中缺血性心肌病6例，扩张型心肌病4例。于CT定位下用0．7mm（22G）穿刺针经皮穿刺至右侧肾动脉附近，注入局部麻醉药0．25％盐酸罗哌卡因15mL，以阻滞肾神经。在肾神经阻滞前后24h分别测定血、尿电解质、血浆神经内分泌激素、肾神经阻滞前和后的24h总尿量，计算尿钠排泄率。并连续监测肾神经阻滞前后心率、血压的变化和呼吸困难、浮肿等心衰症状的改善情况。结果肾神经阻滞后，心衰患者的24h总尿量和尿钠排泄率明显增加，血浆神经内分泌激素水平较肾神经阻滞前降低；心率和平均动脉压无明显变化，呼吸困难、浮肿等心衰症状改善；未发现明显并发症。结论局部阻滞肾神经作为一种新的治疗慢性充血性心衰的方法是安全、有效并且是可行的，临床可用于治疗药物难以控制的心衰。

Objective To observe the clinical feasibility and effects of regional nerve blockade in patients with heart failure. Methods The study enrolled a total of 10 patients, age range from 55 to 75 years old （average 64 ± 11 years old）. The subject includes 8 males and 2 females, among which 6 cases were ischemic cardiomyopathy and 4 cases were dilated cardiomyopathy. All the patients met the criteria of NYHA class m - heart function with heavy fluid load unresponsive to optimal medical therapy. Patients with diabetes and renal failure were nded out from the study. After application of local anesthesia, 15 mL of 0.25% Naropin was injected inside Gerota＇s fascia to achieve regional nerve blockade under CT guidance. Serum and urine electrolytes, neurohormones, renal clearance of sodium and 24-hour urine volume were recorded 24 h before and after the operation. Variartions in heart rate, blood pressure and symptons of dyspnea and edema were also under monitor. Results After nerve blockade, the 24-hour urine volume and renal sodium clearance increased obviously while the level of neurohormones decreased compared with that before operation. No obvious changes in heart rate and blood pressure were recorded and the symptons of heart failure were improved in the patients after operation. No complication was recorded in the study. Conclusion Regional nerve blockade may be a feasible, safe and effective treatment for congestive heart failure patients who do not respond well to the existing optimal medical therapy.