超声引导下交感神经阻滞治疗难治性心绞痛的疗效及对心肌氧耗指数的影响

摘要

Objective To investigate the clinical effects of ultrasound-guided sympathetic nerve block in the treatment of refractory angina pectoris and its influence on the index of myocardial oxygen consumption.Methods Sixty patients with refractory angina pectoris who were diagnosed and treated in our hospital were randomly divided into observation group (n =30) and control group (n =30).The patients in control group were treated by blind injection of ropivacaine (15ml,0.375％),whereas those in observation group were treated by ultrasound-guided sympathetic nerve block with ropivacaine (15ml,0.375％).After treatment the therapeutic effects were evaluated.Moreover the attack frequency and duration of angina pectoris during the experiment as well as before and after treatment were recorded.In addition,the index of myocardial oxygen consumption (SBP × HP) was calculated and the changes of hemodynamic indexes were measured.Results The efficient rate and total effective rate in observation group were significantly higher than those in control group (P ＜ 0.05).After treatment the attack frequency and duration of angina pectoris attacks were obviously decreased in both groups,moreover,which in observation group were significantly lower than those in control group (P ＜ 0.05).After treatment,the SBP × HP in both groups was decreased significantly,and the decreases degree in observation group was more significant than that in control group (P ＜ 0.05).As compared with those in control group,the efficient rate and total effective rate in observation group were significantly increased (P ＜ 0.05).In addition,the hemodynamic indexes in both groups were improved effectively after treatment,moreover,the improvement degree in observation group was more significant than that in control group (P ＜ 0.05).Conclusion The ultrasound-guided sympathetic nerve block can obtain satisfactory therapeutic effects on refractory angina pectoris,which can improve the attack frequency and duration of angina pectoris,and improve the indexes of oxygen consumption and hemodynamics,therefor,which is worth using widely in clinical practice.%目的 探讨超声引导下交感神经阻滞治疗难治性心绞痛的临床效果及对心肌氧耗指数的影响.方法 选择60例诊断明确的难治性心绞痛患者,随机分为研究组和对照组,每组30例.对照组盲探下交感神经阻滞,研究组超声引导下交感神经阻滞,分别于盲探或超声引导下于治疗位点单次注入0.375％罗哌卡因15 ml.评价治疗效果、记录试验期间心绞痛的发作情况及治疗前后心绞痛发作次数及持续时间,计算心肌氧耗指数(SBP×HP),并检测治疗前后血流动力学指标变化.结果 研究组心绞痛治疗显效率、总有效率明显高于对照组,差异有统计学意义(P＜0.05);2组患者治疗后心绞痛发作次数及持续时间计分较治疗前明显降低,且研究组发作次数及持续时间计分明显低于对照组,差异有统计学意义(P＜0.05);治疗后2组患者24h心肌耗氧指数明显下降,且研究组下降幅度较对照组更为显著,差异均有统计学意义(P＜0.05);与对照组比较,研究组心绞痛治疗显效率、总有效率明显升高(P＜0.05);2组患者治疗后血流动力学各指标与治疗前相比均得到了有效改善,且观察组比对照组改善更为明显,差异均有统计学意义(P＜0.05).结论 超声引导交感神经阻滞麻醉治疗难治性心绞痛效果满意,患者疼痛发作次数及持续时间、24h心肌耗氧指数及血流动力学均有所改善,值得临床广泛应用.