心区交感神经阻滞对严重心力衰竭左室收缩功能的影响

Effects of cardiac sympathetic blockade on left ventricular systolic function in patients with severe heart failure

目的在心脏交感神经传出纤维的近端-胸段硬膜外腔内阻滞心区交感神经，以观察心区交感神经阻滞（TEB）对于严重心力衰竭患者的疗效。方法随机选择40名有严重心力衰竭的患者，分为TEB组（n=24）和对照组（n=16）。对照组给予常规抗心力衰竭治疗，不给予β受体阻滞剂。TEB组在对照组常规治疗的同时用0．5％利多卡因每2小时经胸段硬膜外导管推注一次（夜间睡眠除外），阻滞心区交感神经（胸1—5）。于治疗前和治疗后1个月测量左房收缩末期内径（Lad）、左室舒张末期内径（LVEDd）、短轴缩短率（FS）、射血分数（EF），采用成组设计和配对t检验比较两组治疗前后上述指标变化。结果TEB组心功能分级改善程度（1．74±0．54）级明显好于对照组（1．06±0．63）级（P〈0．05）。与对照组相比，TEB组中Lad（38．16±5．28）mm、LVEDd（67．26±7．42）mm显著缩小（P〈0．05），EF（41．18±9．95）％和FS（17．77±4．06）％明显增加（P〈0．05）。结论TEB不仅能显著改善严重心力衰竭的症状，还能显著改善心脏功能，表明即使是在心力衰竭的严重失代偿期，心脏交感神经阻滞也安全、有效。

Objective To study cardiac sympathetic blockade （TEB） on severe heart failure. Method Forty patients with severe heart failure were randomly selected and divided into cardiac sympathetic blockade group （ TEB, n = 24） and control group （ n = 16）. In control group, routine anti-heart-failure therapy was administered without β blocker. In TEB group, besides the routine treatment, cardiac sympathetic blockade （T1-5） was given by injection of 0.5 % lidocaine per 2 hours through thoracic epidural catheter except at the night. Left atrial endsystolic diameter （lad）, left ventricular end-diastolic diameter （LVEDd）, fractional shortening （FS）, ejection fraction （FS） were measured by transthoracic echocardiography and were compared before and at one month after treatment in both groups. Results The cardiac functional improvement was better in TEB group （ 1.74 ± 0.54） class than that in control group （ 1.06 ± 0.63） class （ P 〈 0.05）. Compared with control group, Lad （38.16 ± 5.28） mm, LVEDd （67.26 ± 7.42） mm were reduced （ P 〈 0.05）, EF （41.18 ± 9.95） % and FS （ 17.77 ± 4.06） % were increased signiilcanfly （ P 〈 0.05 ） in TEB group. Conduslons TEB could not only relieve symptoms, but also improve cardiac function in patients with severe heart failure. This suggests that TEB is safe and effective even during the severe decompensation of heart failure.