心区交感神经阻滞对扩张型心肌病左室重塑的影响

Effects on left ventricular remodeling in patients with dilated cardiomyopathy by blockage of cardiac sympathetic nerve

目的 探讨心区交感神经阻滞对扩张型心肌病 (dilatedcardiomyopathy,DCM)左室重塑的影响 ,以寻求DCM治疗新法。方法 2 0 0 0年 5月至 2 0 0 2年 5月临床诊断为DCM患者 6 0例 (符合WHO标准 ) ,随机分成治疗组和对照组。治疗组实施上胸段硬膜外阻滞 ,4周一疗程 ,适当辅以常规药物。对照组仅给予常规药物治疗。应用彩色多普勒超声诊断仪常规方法测量左室重塑指标。结果 治疗组症状体征缓解迅速 ,而对照组缓解较慢 ,有的患者无效甚至加重。治疗组收缩功能提高 ,左室重塑指标得以改善[LVEDD (71 7± 9 3)mmvs (6 6 2± 8 8)mm ,EF (31 1± 17 0 ) %vs (36 6± 12 0 ) % ,FS (12 0± 1 0 ) %vs(15 0± 3 0 ) % ,LVEDV (393 3± 14 4 8)mlvs (343 2± 137 1)ml,LVESV (2 82 5± 12 1 1)mlvs (2 2 7 3±10 8 6 )ml,LVmass (394 3± 10 0 7)gvs (372 1± 93 2 )g,P <0 0 5 ],而对照组无改善。结论 心区交感神经阻滞治疗DCM能中止并逆转DCM左室重塑。

Objective To investigate the influence of block of cardiac sympathetic nerve blockage on left ventricular remodeling in patients with dilated cardiomyopathy(DCM),and to explore a new therapeutic method for DCM.Methods 60 consecutive cases with dilated cardiomyopathy were enrolled,were divided randomly into therapeutic group and control group.Patients in therapeutic group were treated with persistent thoracic epidural anesthesia (T1-5)(TEA), with intermittent 0.5% lidocaine injection every two hours for four weeks,in addition to routine treatment.Patients in control group only received routine treatment.Index of left ventricular remodeling was assessed with Doppler echocardiogram.Results All patients in therapeutic group felt better within five minutes after injection of lidocaine with local epidural. The chest fightness, palpitation, dyspnea were relieved more rapidly than patients in control group. And some patients in therapeutic group with NYHA class IV could lie down supine for a short time. The urine volume was increased, abdominal distention and edema were gradually relieved, and their appetite also approred.Parameters of left ventricular remodeling and cardiac systolic function in TEA group were improved compared with control group. Conclusion Block age of cardiac sympathetic nerve has beneficial effects on clinical symptoms and signs in patients with DCM without any adverse impact.It can also reverse left ventricular remodeling.