心交感神经阻滞对扩张型心肌病二尖瓣和三尖瓣返流的影响  

Effects of cardiac sympathetic blockade on mitral and tricuspid regurgitation in patients with dilated cardiomyopathy

作　　者：修春红[1] 刘凤岐[1] 王怀泉[2] 沈景霞[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心内科,黑龙江哈尔滨150001 [2]哈尔滨医科大学附属第二医院麻醉科,黑龙江哈尔滨150001

出　　处：《心脏杂志》2005年第6期552-554,共3页Chinese Heart Journal

基　　金：黑龙江省"十五"科技攻关项目资助(GB01C126-03)

摘　　要：目的:观察心交感神经阻滞对扩张型心肌病二、三尖瓣返流的影响.方法:选取扩张型心肌病患者32名,随机分为对照组(n=14)和治疗组(n=18).对照组给予常规治疗,治疗组在常规治疗的同时给予心区交感神经阻滞(胸1～5),5g/L利多卡因每2h经胸段硬膜外导管推注一次(夜间睡眠除外).于治疗前和1个月后进行常规经胸心脏彩超检查,测量左室舒张末期内径(LVEDD),左房收缩末期内径(LADs),左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣(MRA)和三尖瓣(TRA)最大的返流面积,计算返流面积占各自心房面积的百分数(二尖瓣MRAP,三尖瓣TRAP)来衡量返流的严重程度.并测量三尖瓣返流速度,计算肺动脉压(PAP),比较治疗组与对照组上述指标的差异.结果:治疗组LADs和LVEDD均较治疗前明显缩小,LVEF和FS较治疗前显著增加.治疗组MRA、TRA、MRAP和TRAP均较治疗前明显减少(MRA 13±4vs7±3 mm2,P＜0.01;TRA 7.68±3.55vs1.75±0.21 mm2,P＜0.01),PAP也明显降低(34±17vs15±7 mmHg,1 mmHg=0.133 kPa,P0.01).而对照组上述指标治疗前后无明显变化.结论:心交感神经阻滞在明显缩小扩张型心肌病的心腔大小,增强左心室收缩功能的基础上能显著减少二尖瓣和三尖瓣的返流,这为改善扩张型心肌病的预后提供了依据.AIM ： To observe the effects of cardiac sympathetic blockade on mitral and tricuspid regurgitation in patients with dilated cardiomyopathy. METHODS：Thirty two patients with dilated cardiomyopathy were randomly selected and divided into control group （n = 14） and therapy group （n = 18）. Patients in the control group received routine treatment only with digitalis, diuretics, vasodilators. And patients in the therapy group were given cardiac sympathetic blockade by intermittent injection of 5 g/L lidocaine per 2 h through thoracic epidural catheter except for the night in addition to the routine treatment. All the patients were examined by routine transthoracic echocardiography before and one month after the treatment. Left ventricular end-diastolic diameter（ LVEDD）, left atrail end-systolic diameter（LADs）, left ventricular ejection fraction（LVEF） and left ventricular fractional shortening（FS） were measured. The maximal mitral and tricuspid regurgitation area and ratio of them to left and right atrial end-systolic areas were also measured. The maximal velocity of tricuspid regurgitation and pulmonary arterial pressure （PAP） were calculated. RESULTS：In the therapy group, LVEDD and LADs were decreased significantly, and LVEF and FS were increased significantly. MRA, TRA, MRAP, TRAP and PAP were also decreased（MRA 13 ±4mm2vs7±3 mm2,P〈0.01;TRA7,68±3,55vs 1.75±0.21 mm^2,P〈0.01, PAP 34±17vs 15± 7 mmHg, 1 mmHg = 0. 133 kPa,P 〈 0.01 ）. In the control group, the above parameters were not changed significantly. CONCLUSION ： Based on the reduction of cardiac size and improvement of left ventricular systolic function, cardiac sympathetic blockade could significantly reduce mitral and tricuspid regurgitation and improve the prognosis of patients with dilated cardiomyopathy.

关 键 词：交感神经阻滞 扩张型心肌病 二尖瓣返流 三尖瓣返流 

分 类 号：R542.2[医药卫生—心血管疾病]