超声评价心区交感神经阻滞对扩张型心肌病右心腔径及功能的影响  

Effects of Cardiac Sympathetic Blockade on Right Ventricle and Systolic Performance in Patients with Dilated Cardiomyopathy

作　　者：修春红[1] 刘凤岐[1] 王怀泉[2] 王旭[1] 曲仁海[3] 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,哈尔滨市150001 [2]哈尔滨医科大学附属第二医院麻醉科 [3]哈尔滨医科大学附属第一医院麻醉科,哈尔滨市150001

出　　处：《中国超声医学杂志》2006年第7期505-507,共3页Chinese Journal of Ultrasound in Medicine

基　　金：黑龙江省十五科技攻关项目(No.GB01C126-03)

摘　　要：目的以超声心动图为评价手段,探寻心区交感神经阻滞(TEB)对扩张型心肌病(DCM)右心腔径和功能的影响。方法DCM患者43例,分为对照组和TEB组。对照组给与常规抗心力衰竭治疗。TEB组在常规治疗的同时,以0.5%利多卡因每2h经硬膜外导管推注1次(夜间睡眠除外),阻滞心区交感神经(胸1-5)。于治疗前和治疗后1个月行经胸心脏超声检查,测量左心室舒张末期内径(LVEDd),左心室射血分数(LVEF),右心室(RV)横径,右心室射血面积分数(RVEFA),三尖瓣环游离壁组织收缩速度(TVSm)等指标,比较两组上述指标差异。结果TEB组LVEDd和RV横径显著缩小,而LVEF、RVEFA显著增加[RVEFA(0.23±0.08)vs(0.36±0.08),P<0.05],TVSm显著增加[(7.54±2.02)cm/s vs(9.64±2.03)cm/s,P<0.05],而对照组上述指标均无显著变化。结论TEB在改善左心室的腔径和收缩功能同时缩小右心室腔径,改善右心室收缩功能,这为改善DCM的预后奠定了坚实的基础。Objective To investigate the effects of cardiac sympathetic blockade （thoracic epidural block, TEB） on right ventricle diameter size and function in patients with dilated cardiomyopathy （DCM）. Methods Totally 43 DCM patients were randomly selected and divided into the control group and TEB group. Routine treatments of heart failure were given in the control group. In TEB group, TEB （T1-5） was administered by intermittent injection of 0. 50% lidocaine per 2 hours through epidural catheter except for the night. Left ventricular end-diastolic diameter （LVEDd）, left ventricular ejection fraction （LVEF）, right ventricular （RV） transverse diameter, RV area ejection fraction （RVEFA）and tissue systolic velocity of tricuspid annulus at free wall （TVSm）were measured before and one month after treatment and compared between the two groups. Results In TEB group, LVEDd and RV transverse diameter were significantly reduced, LVEF and RVEFA were significantly increased （RVEFA 0. 23±0. 08 vs 0. 36± 0. 08, P〈0. 05）, TVSm were significantly increased （7.54±2.02cm/s vs 9.64±2.03 cm/s, P〈0.05）, while the above parameters had no significantly change in the control group. Conclusions Cardiac sympathetic blockade can reduce left and right ventricular diameters simultaneously,and improve biventricular systolic function,which lay down a stable foundation for the improvement of dilated cardiomyopathy prognosis.

关 键 词：扩张型心肌病 心交感神经阻滞 右心室功能 

分 类 号：R542.2[医药卫生—心血管疾病] R544.1[医药卫生—内科学]