心区交感神经阻滞治疗急性心肌梗死支架置入术后重度心力衰竭的观察  

Therapeutic use of cardiac sympathetic blockade in patients with severe heart failure secondary to acute myocardial infarction after intracoronary stenting

作　　者：王旭[1] 刘凤岐[1] 修春红[1] 吴双[1] 孙萍 曲仁海[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院心内科,150001 [2]黑龙江省第五医院超声室

出　　处：《临床麻醉学杂志》2007年第1期20-21,共2页Journal of Clinical Anesthesiology

摘　　要：目的观察高位硬膜外阻滞（心区交感神经阻滞）对急性心肌梗死冠状动脉内支架置入术后重度心力衰竭（心衰）的疗效。方法高位硬膜外阻滞T1～T5交感神经，间隔2h于管内注射0．5％利多卡因3～5ml，并辅助常规药物治疗，疗程4周，观察8例患者治疗前后的症状、Killip分级及心脏彩超检查心功能参数的变化，测量左心房收缩末期内径（LAD）、左心室舒张末期内径（LVEDd）、左心室射血分数（LVEF）及短轴缩短率（FS）。结果治疗后呼吸困难明显减轻，治疗前后的心功能Killip分级分别为（3．7±0.4）和（2．0±0．5）（P〈0．01），LVEDd分别为（64．7±4．2）和（56．7±4．3）mm（P〈0．01），LVEF分别为（40．4±2．1）％和（56．5±5．2）％（P〈0．01）。结论心区交感神经阻滞对常规方法治疗无效或疗效欠佳的急性心肌梗死冠状动脉内支架置入术后心衰疗效好，可改善心功能。Objective To observe the effects of thoracic epidural blockade on cardiac function in serious heart failure patients secondary to acute myocardial infarction after intraeoronary stenting. Methods Cardiac sympathetic bloekade（T1-T5） by high thoracic epidural anesthesia was used in eight patients in addition to routine medical therapy. The patients were administrated epidurally 0.5 % lidocaine 3-5 ml per 2 h. All patients experienced echocardiography examination before and one month after therapy, The changes of symptoms,Killip class and echocardiography parameters were recorded. Results Cardiac dyspnea was lightened obviously after therapy. Killip class before and after treatment were（3.72±0.4） and （2.0±0. 5） （P〈0.01）, LVEDd（64.7±4.2）and （56.7±4.3） mm（P〈 0.01）, LVEF （40. 4 ± 2.1） % and （56.5±5.2）%（P〈0.01）. Conclusion Cardiac sympathetic blockade has good effects on the patients with severe heart failure secondary to acute myocardial infarction after intracoronary stenting.

关 键 词：硬膜外阻滞 冠状动脉内支架置入术 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病] R541.6[医药卫生—内科学]