摘要
目的 探索心区交感神经阻滞 ,能否改善扩张型心肌病的舒张功能。方法 60例扩张型心肌病患者随机分为治疗组 3 0例和对照组 3 0例。治疗组于胸椎 3～ 4或 4～ 5脊突间隙穿刺留管 ,0 .5 %利多卡因每 2h推注 3～ 5ml(除夜间睡眠外 ) ,4周为一疗程 (加用常规药物 )。对照组除不用心区交感神经阻滞 ,余同治疗组。应用多普勒超声心动图测量每组治疗前后舒张功能指标。结果 ①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。②治疗组舒张充盈模式改善者 13例 ,加重者 1例 ,其余 16例舒张充盈模式未变 ,但也有模式改善趋势。其中 15例限制型充盈模式中 6例改善为假性正常模式 ;9例假性正常充盈模式中 4例改善为延迟舒张充盈模式 ;6例延迟舒张充盈模式中 3例改善为正常充盈模式 ;只有 1例由假性正常充盈模式进展为限制型充盈模式。而对照组舒张充盈模式改善者 1例 ,加重者9例 ,其余 2 0例舒张充盈模式未变。其中 1例由延迟舒张充盈模式改善为正常充盈模式 ,2例由延迟舒张充盈模式进展为假性正常充盈模式 ,7例由假性正常充盈模式进展为限制型充盈模式。结论 心区交感神经阻滞能改善扩张型心肌病的舒张功能 ,对扩张型心肌病有益。
Objective To investigate if diastolic function could be improved by cardiac sympathetic nerve blockade in patients with dilated cardiomyopathy (DCM). Methods Sixty consecutive cases of DCM were randomed into therapeutic group and control group. Patients in therapeutic group were administered thoracic epidural blockade (TEB) (T 1-5 ) with 0.5 % lidocaine intermittent injection every two hours for four weeks, in addition to some routine medicine, while patients in control group were only administered routine treatment. Then the parameters of left ventricular diastolic function were evaluated with Doppler echocardiography before and after four weeks. Results ①All the patients in TEB group felt better within five minutes after injection of lidocaine within local epidural cavity.Their symptoms were relieved more rapidly than those of the drug therapy alone. Some patients with NYHA class Ⅳ could lie down supine in a short time. Exercise tolerance increased in patients with NYHA class Ⅱ to Ⅲ. But symptoms and signs of patients in control group were relieved very slowly, some patients even got worsen. ② Thirteen of thirty in therapeutic group got improvement on diastolic function after treatment. One of thirty in this group deteriorated. In detail, six of fifteen patients with demonstrated improvement of left ventricular diastolic filling changed from having a restrictive filling pattern to having a pseudonormal left ventricular filling pattern. Four of nine patients with a pseudonormal filling pattern changed to have a delayed filling pattern.Three of six patients, left ventricular filling pattern moved from a pseudonormal left ventricular filling pattern to a normal filling pattern. Only one patient acquired a restrictive filling pattern from a pseudonormal filling pattern. In contrast, in control group one of thirty got improvement on diastolic function after treatment. Nine of thirty in this group deteriorated. Individual changes of left ventricular filling pattern showed that only one patient improved
出处
《中华超声影像学杂志》
CSCD
2003年第11期654-656,共3页
Chinese Journal of Ultrasonography
基金
黑龙江省"十五"科技攻关项目 (项目编号GB0 1C1 2 6 0 3)
