【摘要】 目的观察心交感神经阻滞对扩张型心肌病左心室心肌收缩力的影响。方法随机选取30例扩张型心肌病患者,分为对照组(16例)和治疗组(14例)。对照组给予常规抗心力衰竭治疗,治疗组在给予对照组治疗的同时,以0.5%利多卡因每2h经硬膜外导管推注一次(夜间睡眠除外),阻滞心区交感神经(胸1-5)。所有患者于治疗前和治疗后1个月行经胸心脏超声检查,测量左心房收缩末期内径(LAD),左心室舒张末期内径(LVEDd),短轴缩短率(FS),射血分数(EF),二尖瓣环后间隔、侧壁、前壁、下壁、前间隔、后壁的组织峰值收缩速度(Sm)和运动距离(D),计算6个位点的峰值收缩速度和运动距离平均值(MSm和MD),比较两组上述指标的差异。结果治疗组LAD和LVEDd均显著缩小,EF和FS明显增加,对照组上述指标无显著改善。同对照组比,治疗组MSm和MD均显著增加[MSm(4.91±0.56)cm/s对(4.09±0.82)cm/s,P<0.05;MD(0.61±0.18)cm对(0.41±0.18)cm,P<0.05]。左心室射血分数改善与MSm和MD的变化显著相关(MSmr=0.576,P=0.001;MDr=0.526,P=0.003)。结论对于扩张型心肌病,心区交感神经阻滞较常规治疗能显著缩小左心腔径,尤为突出的是它能更有力地增强心肌的收缩力,改善左心室收缩功能。更多还原

【Abstract】 Objective To observe the effect of cardiac sympathetic blockade on left ventricular myocardial contractility in patients with dilated cardiomyopathy. Methods Thirty dilated cardiomyopathy patients were randomly selected and divided into control gruop(n=16) and therapy group(n=14). Routine treatment was given in control group. In therapy group, in addition to routine treatment, cardiac sympathetic blockade was administered by intermittent injection of (0.5)% lidocaine per 2 hours through thoracic epidural catheter except for the night. All the patients experienced transthoracic echocardiography. Left atrial end-systolic diameter(LAD), left ventricular end-diastolic diameter(LVEDd), fractional shortening (FS), ejection fraction(EF), peak tissue systolic velocity(Sm) and excursion(D) at posterior septum, lateral, anterior, inferior, anterior septum and posterior sites of mitral annulus were measured and means of Sm and D(MSm,MD) were calculated. The above parameters were compared between two groups. Results In therapy group, LAD and LVEDd were decreased significantly, EF and FS were increased significantly. While in control group, the above index had no significant change. Compared with control group, MSm and MD were significantly increased[MSm ((4.91)±(0.56))cm/s vs ((4.09)±(0.82))cm/s, P<(0.05); MD ((0.61)±(0.18))cm vs ((0.41)±(0.18))cm,P<(0.05)]. Left ventricular ejection fraction improvement were closely related to improvement of MSm and MD(MSm r=(0.576),P=(0.001); MD r=(0.526),P=(0.003)). Conclusions As for the patients with dilated cardiomyopathy, compared with routine therapy, cardiac sympathetic blockade can reduce left ventricular and atrial diameter, what’s outstanding is that it can more strongly increase myocardial contractility, and improve left ventricular systolic function.更多还原