【摘要】 目的:观察星状神经节阻滞对不稳定型心绞痛患者心肌损伤及生活质量的影响。方法:选择2005-01/12新乡医学院第一附属医院住院治疗的38例不稳定型心绞痛患者,采用随机数字表法随机分为星状神经节阻滞组和对照组各19例。星状神经节阻滞组患者进行星状神经节阻滞治疗,C6横突向尾侧1.5cm处穿刺,注入10g/L利多卡因10mL,每日一侧,交替进行,两周为1个疗程。对照组常规内科治疗。于阻滞前及阻滞后1,3,5,7d抽取静脉血标本,测定肌钙蛋白Ⅰ,以>0.10μg/L为心肌受到损伤。应用目测类比评分(0分为无痛,10分为剧痛)评估患者的镇痛情况。并于1周后用改良巴氏评定表评定患者的生活自理能力(10个项目,总分为100分,0分为无生活自理能力,5～45分为有部分生活自理能力,50～95分为生活基本自理,100分为生活完全自理)。用汉密顿焦虑量表评估精神状态,共有14个项目,满分为42分。0～13分为轻度焦虑,14～27分为中度焦虑,27～42分为重度焦虑。结果:38例进入结果分析。①星状神经节阻滞1d后,星状神经节阻滞组患者心绞痛症状全部缓解,目测类比评分也明显低于阻滞前及同时段对照组值,而且在整个治疗过程中未再出现心前区疼痛。②星状神经节阻滞组肌钙蛋白Ⅰ与阻滞前比较无明显升高,且明显低于同时段对照组值(P<0.05)。③1周后星状神经节阻滞组58%生活自理,32%基本自理,5%部分自理,5%丧失自理;对照组37%生活自理,16%基本自理,37%部分自理,10%丧失自理,两组比较差异显著(P<0.05)。④星状神经节阻滞组79%的患者轻度焦虑,10.5%中度焦虑,10.5%重度焦虑;对照组轻度焦虑为16%,47%中度焦虑,37%重度焦虑,两组比较差异显著(P<0.05)。结论:星状神经节阻滞对不稳定型心绞痛患者心肌损伤有一定保护作用,并明显改善患者生活自理能力和焦虑状态。更多还原

【Abstract】 AIM: To observe the effect of stellate ganglion block on myocardium damnification and quality of life in patients with unstable angina pectoris. METHODS: A total of 38 patients with unstable angina pectoris, who were hospitalized at the First Affiliated Hospital, Xinxiang Medical College from January to December 2005, were selected and divided randomly into stellate ganglion block group (n=19) and control group (n=19). The patients in stellate ganglion block group received stellate ganglion block, punctura in the transverse process of cervical vertebra 6 to caudal 1.5 cm, to inject 10 g/L lidocaine 10 mL once a day, alternation inject, two week was one course of treatment. The patients in control group took routine medicine methods therapy. In preceding block and block 1, 3, 5 and 7 days later, phlebotomized and measured quantum of troponinⅠ, > 0.10 μg/L as injured myocardium. Analgesia was determined with visual analog scale (VAS) (0 point represented painless, 10 points represented severe pain). After one week, their self-care ability was assessed with Modified Barthel Scale (totally 10 items, total score was 100 points; 0 point indicated no self-care ability; 5-45 points indicated partial self-care ability; 50-95 points indicated most self-care ability; 100 points indicated complete self-care ability). Psychosis symptom was evaluated with Hamilton Anxiety Scale (HAMA), totally 14 items, full mark was 42 points; 1-13 points were as mild anxiety; 14-27 points were as moderate anxiety; 27-42 points were as severe anxiety. RESULTS: Thirty-eight patients were involved in the result analysis. ①After 1 day, the patients in stellate ganglion block group lighten angina symptom, score on VAS was obviously lower preceding block and control group, and there was no precordial region pain in the treatment.②Troponin Ⅰ in the stellate ganglion block group did not increase as compared with before block, and was significantly lower than that of the control group in the same period (P < 0.05). ③In the stellate ganglion block group there were 58% of them with self-care ability, 32% of them with most self-care ability, 5% of them with partial self-care ability and 5% of them without self-care ability. In the control group there was 37% of them with self-care ability, 16% of them with most self-care ability, 37% of them with partial self-care ability and 10% of them without self-care ability. The difference was obvious between the two groups (P < 0.05). ④In the stellate ganglion block group there were 79% patients with mild anxiety, 10.5% patients with moderate anxiety, 10.5% patients with severe anxiety. In the control group there were 16% subjects with mild anxiety, 47% subjects with moderate anxiety, 37% subjects with severe anxiety. There was significant difference between the two groups (P < 0.05=. CONCLUSION: Stellate ganglion block has a certain of protective effects on myocardial damage in patients with unstable angina pectoris, and obviously improve self-care ability and anxious status.更多还原