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目的观察心区交感神经阻滞对严重心力衰竭患者左心室舒张功能的影响。方法随机选择有严重心力衰竭,左心室射血分数<35%的扩张型心肌病患者39例,分为心区交感神经阻滞组(TEB组)和对照组。对照组给予常规抗心力衰竭治疗,TEB组在给予药物治疗的同时,予以TEB。于治疗前和治疗后1个月行超声心动图检查,测量左心房内径(Lad)、左心室内径(LVEDd)、左心室射血分数(EF),二尖瓣环6个位点心肌组织舒张早期速度和舒张晚期速度(Em和Am),并取平均值(MEm和MAm),比较两组上述指标变化。结果TEB组Lad、LVEDd显著缩小(LVEDd66mm±6mmvs71mm±6mm,P<0.05),EF显著增加(35%±7%vs23%±6%,P<0.05),二尖瓣环6个位点的Em和3个位点的Am均显著增加,MEm和MAm也显著增加(MEm5.7cm/s±1.5cm/svs7.1m/s±1.7cm/s,P<0.05),对照组Lad、LVEDd和EF无显著变化,二尖瓣环只有2个位点Em显著增加,Am、MEm和MAm均无变化。结论同常规治疗相比,TEB能在缩小严重心力衰竭患者左心室腔径、增强射血功能的同时显著改善左心室舒张功能。
Objective To observe the effects of cardiac sympathetic nerve block on left ventricular diastolic function in patients with severe heart failure. Methods Thirty-nine patients with dilated cardiomyopathy who had severe heart failure and left ventricular ejection fraction <35% were randomly divided into the cardiac sympathetic nerve block group (TEB group) and the control group. The control group was given routine anti-heart failure treatment, while the TEB group was given TEB while receiving drug treatment. Before treatment and 1 month after treatment, echocardiography was performed to measure left ventricular diameter (Lad), left ventricular diameter (LVEDd), left ventricular ejection fraction (EF), mitral annular dilation Early and late diastolic velocities (Em and Am), and the average (MEm and MAm) were compared between the two groups changes in the above indicators. Results In the TEB group, the values of Lad and LVEDd were significantly reduced (LVEDd66mm ± 6mm vs71mm ± 6mm, P <0.05), EF significantly increased (35% ± 7% vs23% ± 6%, P <0.05) And Am at 3 sites were significantly increased, MEm and MAm also increased significantly (MEm5.7cm / s ± 1.5cm / svs7.1m / s ± 1.7cm / s, P <0.05) No significant change, only two sites of mitral annulus Em significantly increased, Am, MEm and MAm were no change. Conclusion Compared with conventional treatment, TEB can significantly improve left ventricular diastolic function while reducing left ventricular cavity diameter and enhancing ejection function in patients with severe heart failure.