胸段交感神经干预对糖尿病心力衰竭病人的影响

摘要

目的:观察胸段交感神经阻滞对糖尿病伴有心腔扩大心力衰竭病人的疗效.方法:76例糖尿病伴有心腔扩大心力衰竭病人随机被分为:常规治疗组(36例)和硬膜外神经阻滞组(神经阻滞组,40例,常规治疗基础上加用高位硬膜外神经阻滞),4周为一个疗程,观察两组左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心房内径(LAD)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、脑钠肽(BNP)、糖化血红蛋白(HbA1c)等指标的变化.结果:两组各指标在治疗前无显著差异.治疗后神经阻滞组心功能改善有效率明显高于常规治疗组(95.0％比66.7％,P＜0.05).与治疗前比较,治疗后神经阻滞组LVEDd[(71.63±9.26) mm比(65.4±8.12)mm]、LAD [(45.62±7.10) mm比(37.14±6.28) mm]明显缩小(P均＜0.05),LVEF[(31.3±11.46)％比(42.12±10.42)％]明显提高(P＜0.01),TNF-α[(73.55±16.36) ng/L比(28.35±10.08) ng/L]、IL-6[(17.62±5.47) ng/L比(7.88±2.29) ng/L]、BNP[(13.49±2.94) ng/L比(6.28±2.28) ng/L]、HbA1c[(7.9±2.6)％比(6.8±1.9)％]水平明显下降(P＜0.05或＜0.001)；且LVEF、TNF-α、IL-6、BNP水平均较常规治疗组治疗后明显改善(P＜0.05或＜0.01).结论:胸段交感神经阻滞显著降低糖尿病心力衰竭病人的神经内分泌因子、炎性因子水平,明显改善心功能,提高了生活质量.%Objective:To observe curative effect of thoracic sympathetic block on patients with diabetes mellitus (DM) complicated cardiac chamber enlargement and heart failure (HF).Methods:A total of 76 DM patients with cardiac chamber enlargement and HF were randomly divided into routine treatment group (n =36) and epidural nerve block group (nerve block group,n=40,received thoracic epidural nerve block based on routine treatment),and four weeks were a course of treatment.Changes of left ventricular ejection fraction (LVEF),left ventricular end-diastolic dimension (LVEDd),left atrial diameter (LAD),levels of tumor necrosis factor-α (TNF-α),i nterleukin-6 (IL-6),brain natriuretic peptide (BNP) and glycosylated hemoglobin (HbA1c) were observed in two groups.Results:There were no significant difference in all indexes between two groups before treatment (P＞0.05).After treatment,total effective rate of cardiac function improvement in nerve block group was significantly higher than that of routine treatment group (95％ vs.66.7％,P＜0.05).Compared with before treatment,there were significant decrease in LVEDd [(71.63±9.26) mm vs.(65.4±8.12) mm] and LAD [(45.62±7.10) mm vs.(37.14±6.28) mm] (P＜0.05 both),significant increase in LVEE [(31.3± 11.46)％ vs.(42.12± 10.42) ％,P＜0.01],and significant decrease in levels of TNF-α [(73.55±16.36) ng/L vs.(28.35±10.08) ng/L],IL-6 [(17.62±5.47) ng/L vs.(7.88±2.29) ng/L],BNP [(13.49±2.94) ng/L vs.(6.28±2.28) ng/L] and HbA1c [(7.9±2.6) ％ vs.(6.8±1.9) ％] in nerve block group after treatment,P＜0.06 or ＜0.001; and levels of LVEF,TNFα,IL-6 and BNP in nerve block group after treatment were significantly improved than those of routine treatment group,P＜0.05 or ＜0.01.Conclusion:Thoracic sympathetic block can significantly decrease levels of neuroendocrine and inflammatory factors,improve cardiac function,and elevate quality of life in patients with diabetes mellitus complicated heart failure.