上胸段硬膜外阻滞对缺血性心肌病顽固性心力衰竭患者血浆N末端原脑利钠肽浓度的影响

目的 评价上胸段硬膜外阻滞(HTEB)对缺血性心肌病(ICM)顽固性心力衰竭患者血浆N末端原脑利钠肽(NT-proBNP)浓度的影响.方法 ICM顽固性心力衰竭患者30例,年龄45～64岁,体重52～73kg,NYHA分级Ⅲ或IV级,随机分为2组:对照组(C组,n=14)和上胸段硬膜外阻滞组(HTEB组,n=16).C组行常规抗心力衰竭药物治疗;HTEB组于T3.4或T4,5间隙行硬膜外阻滞,阻滞范围T1-5,每隔2 h硬膜外腔注射0.5%利多卡因3 ml,每日6次,夜间停止给药,并辅以常规抗心力衰竭药物治疗.两组疗程均为4周.所有患者均于治疗前、治疗4周后行超声心动图检查,测量左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室短轴缩短率(LVFS)、左心室舒张末期容积(LVEDV)及收缩末期容积(LVESV),计算左心室射血分数(LVEF).于治疗前和治疗2周后抽取静脉血样,采用电化学发光法检测血浆NT-proBNP浓度.结果 与治疗前比较,HTEB组治疗后LVEDD降低、LVEF和LVFS升高、血浆NT-proBNP浓度降低(P<0,05),c组上述指标差异无统计学意义(P>0.05).与C组比较,HTEB组治疗后LVEDD降低、LVEF和LVFS升高、血浆NT-proBNP浓度降低(P

Effects of high thoracic epidural blockade on concentration of plasma N-terminal- pro- brain natriuretic peptide in ischemic cardiomyopathy patients with refractory heart failure

Objective To evaluate the effects of high thoracic epidural blockade (HTEB) on the concentration of plasma N-terminal-pro-brain natriuretic peptide (NT-proBNP) in ischemic cardiomyopathy (ICM) patients with refractory heart failure (HF) .Methods Thirty ICM patients with refractory HF, NYHA grade ID or IV , were randomly divided into 2 groups: control group (group C) underwent routine anti-HF treatment ( n = 14), and HTEB group underwent HTEB at the interspinal space T3,4 or T4,5 in addition to the routine anti-HF treatment (n = 16). High thoracic epidural blockade (T1-5) was used in group HTEB. The patients in HTEB group were administrated epidurally 0.5% lidocaine 3 ml per 2 h during the day time. All patients experienced echocard-iography examination before treatment and after four week treatment. The changes of echocardiography parameters were recorded. Venous blood samples were taken before treatment and after two week treatment to determine the concentration of plasma NT-proBNP. Results The left ventricular end-diastolic diameter ( LVEDD) was significantly lower, left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) higher, and concentration of plasma NT-proBNP lower after treatment than before treatment in group HTEB, but there were no significant differences in the indices mentioned above between before and after treatment in group C. The LVEDD was significantly lower, LVEF and LVFS higher, and concentration of plasma NT-proBNP lower after treatment in group HTEB than in group C. Conclusion High thoracic epidural blockade can decrease the plasma NT-proBNP concentration and improve cardiac function in ICM patients with refractory HF.