高位硬膜外阻滞治疗克山病疗效观察

Treatment of Keshan disease by application of thoracic epidural blockade

目的 探讨高位硬膜外阻滞术对慢型克山病患者心脏收缩功能及心腔大小的影响。方法 9例慢型克山病心力衰竭患者 ,NYHA(纽约心脏病协会 )心功能分级为 ～ 级 ,胸 3- 4或胸 4 - 5棘突间隙穿刺至硬膜外腔 ,留置硬膜外导管 ,每 2 h推注 1次 0 .5 %利多卡因 3～ 5 m l,阻滞胸 1 - 5交感神经 ,持续 4～ 6周。观察高位硬膜外阻滞前及阻滞后 4周临床症状、体征、心功能改善情况。结果 高位硬膜外阻滞治疗过程中 ,所有患者临床症状、体征缓解迅速。治疗 4周后 ,患者 NYHA心功能分级改善。超声心动显示心脏收缩功能提高 ,心腔缩小。结论 高位硬膜外阻滞可改善慢型克山病心力衰竭患者心脏功能 ,缩小扩大的心腔。

Objective To explore the effects of thoracic epidural blockade on cardiac systolic functions and cardiac cavities of patients with chronic Keshan disease.Methods Nine patients with chronic Keshan disease received continuous cardiac sympathetic blockade by intermittent injection of 0.5% lidocaine for about 4 weeks in addition with routine therapy. Patients' symptoms,signs and cardiac classification were observed and assessed during the therapy. Results During the treatment of thoracic epidural blockade, all patients' symptoms and signs improved significantly and quickly. Four weeks later, all patients' classification of NYHA improved. Echocardiography showed that systolic functions increased and cardiac cavities decreased.Conclusions Thoracic epidural blockade can significantly improve the cardiac functions and reduce the cavities of patients with chronic Keshan disease.