胸段交感神经干预对糖尿病心力衰竭病人的影响(英文)

Influence of thoracic sympathetic block on patients with diabetes mellitus complicated heart failure

目的:观察胸段交感神经阻滞对糖尿病伴有心腔扩大心力衰竭病人的疗效。方法:76例糖尿病伴有心腔扩大心力衰竭病人随机被分为:常规治疗组(36例)和硬膜外神经阻滞组(神经阻滞组,40例,常规治疗基础上加用高位硬膜外神经阻滞),4周为一个疗程,观察两组左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心房内径(LAD)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、脑钠肽(BNP)、糖化血红蛋白(HbA1c)等指标的变化。结果:两组各指标在治疗前无显著差异。治疗后神经阻滞组心功能改善有效率明显高于常规治疗组(95.0%比66.7%,P<0.05)。与治疗前比较,治疗后神经阻滞组LVEDd[(71.63±9.26)mm比(65.4±8.12)mm]、LAD[(45.62±7.10)mm比(37.14±6.28)mm]明显缩小(P均<0.05),LVEF[(31.3±11.46)%比(42.12±10.42)%]明显提高(P<0.01),TNF-α[(73.55±16.36)ng/L比(28.35±10.08)ng/L]、IL-6[(17.62±5.47)ng/L比(7.88±2.29)ng/L]、BNP[(13.49±2.94)ng/L比(6.28±2.28)ng/L]、HbA1c[(7.9±2.6)%比(6.8±1.9)%]水平明显下降(P<0.05或<0.001);且LVEF、TNF-α、IL-6、BNP水平均较常规治疗组治疗后明显改善(P<0.05或<0.01)。结论:胸段交感神经阻滞显著降低糖尿病心力衰竭病人的神经内分泌因子、炎性因子水平,明显改善心功能,提高了生活质量。

Objective：To observe curative effect of thoracic sympathetic block on patients with diabetes mellitus（DM） complicated cardiac chamber enlargement and heart failure（HF）.Methods：A total of 76 DM patients with cardiac chamber enlargement and HF were randomly divided into routine treatment group（n=36） and epidural nerve block group（nerve block group,n=40,received thoracic epidural nerve block based on routine treatment）,and four weeks were a course of treatment.Changes of left ventricular ejection fraction（LVEF）,left ventricular end-diastolic dimension（LVEDd）,left atrial diameter（LAD）,levels of tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,brain natriuretic peptide（BNP） and glycosylated hemoglobin（HbA1c） were observed in two groups.Results：There were no significant difference in all indexes between two groups before treatment（P〈0.05）.After treatment,total effective rate of cardiac function improvement in nerve block group was significantly higher than that of routine treatment group（95% vs.66.7%,P〈0.05）.Compared with before treatment,there were significant decrease in LVEDd [（71.63±9.26） mm vs.（65.4±8.12） mm ] and LAD [（45.62±7.10） mm vs.（37.14 ±6.28） mm ]（P〈0.05 both）,significant increase in LVEF [（31.3±11.46） % vs.（42.12± 10.42） %,P 0.01 ],and significant decrease in levels of TNF-α [（73.55±16.36） ng/L vs.（28.35±10.08） ng/L ],IL-6 [（17.62 ±5.47） ng/L vs.（7.88±2.29） ng/L ],BNP [（13.49±2.94） ng/L vs.（6.28±2.28） ng/L ] and HbA1c [（7.9± 2.6） % vs.（6.8±1.9） % ] in nerve block group after treatment,P〈0.05 or0.001;and levels of LVEF,TNFα,IL-6 and BNP in nerve block group after treatment were significantly improved than those of routine treatment group,P〈0.05 or0.01.Conclusion：Thoracic sympathetic block can significantly decrease levels of neuroendocrine and inflammatory factors,improve cardiac function,and elevate quality of life in patients with diabetes mellitus complicated heart failure.