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目的:探讨交感神经阻滞对有糖尿病、心腔扩张的顽固心衰患者心脏收缩功能和心腔大小的影响。方法:经胸3～胸4棘突间隙穿刺至硬膜外腔,留置硬膜外导管,0.5%利多卡因3～5ml每2h推注一次,持续4w,适当辅以常规治疗。测定并比较TEB治疗前及后4w射血分数(EF)、左室内径(LVED)和左房内径(LAED)等指标的变化。结果:治疗后左室射血分数(EF)由治疗前的(31.53±9.29)%升为(44.75±8.32)%(P<0.05);左室内径(LVED)由治疗前的(70.59±6.25)mm缩减到(63.59±7.05)mm(P<0.05);左房内径(LAED)由治疗前的(46.16±7.19)mm缩减到(39.05±7.23)mm(P<0.05)。结论:心区交感神经阻滞结合常规用药对有糖尿病、心腔扩张的顽固心衰患者的心脏功能有明显改善作用,并使其扩大的心脏明显缩小。
Objective: To investigate the effect of sympathetic nerve block on cardiac contractile function and cardiac cavity in patients with stubborn heart failure with diabetes and cardiac expansion. Methods: The epidural space was punctured through the interspace between the thoracic and thoracic spines of the thoracic spine, the epidural catheter was placed and the 0.5% lidocaine 3 ~ 5ml was bolted every 2 hours for 4 weeks, supplemented with routine treatment as appropriate. The changes of ejection fraction (EF), left ventricular diameter (LVED) and left atrium diameter (LAED) before and after TEB treatment were measured and compared. Results: The left ventricular ejection fraction (EF) increased from (31.53 ± 9.29)% before treatment to (44.75 ± 8.32)% after treatment (P <0.05) ) mm reduced to (63.59 ± 7.05) mm (P <0.05); LAED decreased from 46.16 ± 7.19 mm to 39.05 ± 7.23 mm before treatment (P <0.05). CONCLUSIONS: Sympathetic nerve block in heart area combined with conventional medication can significantly improve cardiac function in patients with stubborn heart failure with diabetes mellitus and dilatation of cardiac chambers, and significantly enlarge the enlarged heart.