胸段硬膜外阻滞对急性心肌梗塞伴急性左心衰患者血浆AngⅡ、IL-10和TNF-α浓度的影响

Effects of thoracic epidural block on plasma Ang Ⅱ , IL-10 and TNF-α concentrations in patients with acute myocardial infarct complicated by left heart failure

目的探讨胸段硬膜外阻滞（TEB）对急性心肌梗塞（AMI）伴急性左心衰患者血浆血管紧张素（Ang）Ⅱ、白细胞介素（IL）-10、肿瘤坏死因子（TNF）-α浓度的影响。方法AMI伴急性左心衰患者60例,Killip心功能分级Ⅲ级或Ⅳ级,随机分为2组,对照组（n=32）给予常规治疗;TEB组（n= 28）在给予常规治疗的基础上,于T3,4行硬膜外阻滞,头向置管固定,阻滞成功后硬膜外腔注射0.5%利多卡因5ml,1次/2h（夜间睡眠期间除外）,持续治疗1周。分别于治疗前、治疗2、4、6h和1周时测定血浆AngⅡ、IL-10和TNF-α浓度,于治疗前和治疗1周时测定左室射血分数（LVEF）、左室射血时间（LVET）和短轴缩短率（FS）。结果与对照组比较,TEB组血浆AngⅡ和TNF-α浓度降低,IL-10浓度升高,LVEF、LVET和FS均升高（P〈0.05）;与治疗前比较,TEB组血浆AngⅡ和TNF-α浓度降低,IL-10浓度升高,LVEF、LVET和FS升高（P〈0.05）。结论AMI伴急性左心衰患者早期应用TEB治疗可降低血浆AngⅡ和TNF-α浓度,升高血浆IL-10浓度,从而迅速改善心功能。

Objective To investigate the effects of thoracic epidural block （TEB） on plasma concentrations of angiotensin Ⅱ （ Ang Ⅱ ）, interleukin- 10 （ IL- 10 ） and tumor necrosis factor-α （TNF-α） in patients with acute myocardial infarct （AMI） complicated by acute left heart failure. Methods Sixty patients with AMI complicated by acute left heart failure aged 46-64 yr weighing 53-75 kg were enrolled in this study. Their cardiac function was of grade Ⅲ or Ⅳ according to European Society of Cardiology. The patients were randomly divided into ：2 groups; Ⅰ control group received only routine treatment （ n = 32） and Ⅱ TEB group received TEB besides the routine treatment （ n = 28） . TEB was performed at T3,4 interspace. A catheter was inserted into epidural space and advanced 3 cm cephalad and fixed. 0.5% lidocaine 5 ml was injected through the catheter every 2 h during the day. Blood samples were taken immediately before and at 2, 4, 6 h and 1 week of treatment for determination of plasma concentrations of Ang Ⅱ , IL-10 and TNF-α. Left ventricular ejection fraction （LVEF）, left ventricular ejection time （LVET） and fractional shortening （FS） were measured before and a week after TEB treatment was started by echocardiography. Results Plasma Ang Ⅱ and TNF-α concentration were significantly lower and plasma IL-10 concentrations were significantly higher at the corresponding time points after treatment was started in TEB group than in control group. LVEF, LVET and FS were significantly increased after one week TEB treatment as compared with the baseline values before TEB in TEB group. Conclusion TEB can decrease plasma Ang Ⅱ and TNF-α concentrations and increase plasma IL-10 concentration and improve cardiac function rapidly in patients with AMI.