交感神经阻滞对糖尿病心腔扩张顽固心衰的疗效

The Effect of Thoracic Epidural Blockade on Refractory Heart Failure in Patients with Diabetes Mellitus and Cardiomegaly

目的:探讨交感神经阻滞对有糖尿病、心腔扩张的顽固心衰患者心脏收缩功能和心腔大小的影响。方法:经胸3～胸4棘突间隙穿刺至硬膜外腔,留置硬膜外导管,0.5%利多卡因3～5ml每2h推注一次,持续4w,适当辅以常规治疗。测定并比较TEB治疗前及后4w射血分数(EF)、左室内径(LVED)和左房内径(LAED)等指标的变化。结果:治疗后左室射血分数(EF)由治疗前的(31.53±9.29)%升为(44.75±8.32)%(P<0.05);左室内径(LVED)由治疗前的(70.59±6.25)mm缩减到(63.59±7.05)mm(P<0.05);左房内径(LAED)由治疗前的(46.16±7.19)mm缩减到(39.05±7.23)mm(P<0.05)。结论:心区交感神经阻滞结合常规用药对有糖尿病、心腔扩张的顽固心衰患者的心脏功能有明显改善作用,并使其扩大的心脏明显缩小。

Objective：To investigate the impact of thoracic epidural blockade（TEB） on cardiac performance and cavities of patients with refractory heart failure（RHF） by diabetes mellitus and cardiomegaly.Methods：The patients with RHF by diabetes mellitus and cardiomegaly were selected as subjects.All patients received continuous TEB by intermittent injection of 0.5% lidocaine for about 4 weeks in addition with routine therapy.Cardiac systolic performance and cavities were measured and compared before and four weeks after treatment of TEB.Results：Four weeks later：（1） EF rose from（31.53 ± 9.29） % to（44.75 ± 8.32） %,P0.05;（2） LVED reduced from（70.59 ± 6.25） mm to（63.59 ± 7.05） mm,P0.05;（3） LAED reduced from（46.16 ± 7.19） mm to（39.05 ± 7.23） mm,P0.05.Conclusion：The therapy of TEB can improve cardiac function and reduce cardiac cavities of patients with RHF by diabetes mellitus and cardiomegaly.