高位硬膜外阻滞对扩张型心肌病心脏收缩功能的延迟作用

Delayed effects of thoracic epidural blockade on cardiac function of patients with dilated cardiomyopathy

目的 探讨高位硬膜外阻滞 (TEB)治疗停止后扩张型心肌病患者心脏收缩功能是否继续改善。方法 上胸段棘突间穿刺至硬膜外腔 ,留置硬膜外导管 ,0 .5 %利多卡因 3～ 5ml每 2h推注一次 ,持续 4周 ,适当辅以常规治疗。测定并比较TEB治疗停止后 16周及停止初期扩张型心肌病患者射血分数(EF)、缩短分数 (FS)。结果 16周后EF值由 2 8.2 1%± 7.2 2 %升为 34.5 4%± 6 .16 %(P =0 .0 195 ) ,FS由 10 .5 7%± 2 .98%升为 13.43%± 3.18%(P =0 .0 2 12 )。结论 高位硬膜外阻滞治疗停止后扩张型心肌病患者心脏收缩功能继续改善 ,该方法对扩张型心肌病患者心脏收缩功能改善具有延迟作用。

Objective To investigate if cardiac function of patients with dilated cardiomyopathy (DCM) improved continuously when the treatment of thoracic epidural blockade (TEB) ceased.Methods Fifteen patients with DCM received continuous TEB by intermittent injection of 0.5% lidocaine 3～5 milliliters for 4 weeks. When TEB was ceased, left ventricular ejection fraction (EF) and fractional shortening (FS) were measured. Sixteen weeks after, the two parameters were measured again in 15 patients and the results were compared with those of initial stage.Results Sixteen weeks after cease of TEB, the value of EF rose from 28.21%± 7.22% to 34.54%± 6.16% (P= 0.019 5) and FS rose from 10.57%± 2.98% to 13.43%± 3.18% (P= 0.021 2).Conclusions Even though treatment of TEB was ceased, the rise of cardiac function of patients with DCM went on. The method of TEB has the delayed and beneficial effects on cardiac function of patients with DCM.