上胸段硬膜外阻滞治疗慢性心力衰竭合并房颤的临床研究

目的:比较上胸段硬膜外阻滞对有无合并房颤的扩张型心肌病心衰患者的疗效差异。方法:入选40例扩张型心肌病心衰患者,根据入院心电图有无房颤分为房颤组和非房颤组。所有患者均在抗心力衰竭常规治疗基础上,给予胸段硬膜外阻滞治疗4周,比较治疗前、后NYHA心功能分级、血浆N末端脑钠肽前体(NT-pro BNP)水平、左室射血分数(LVEF)、左室舒张期内径(LVEDD)及左房前后径(LAD)的变化情况。结果:与治疗前比较,两组患者经治疗后的NYHA心功能分级、NT-pro BNP、LVEF、LVEDD及LAD均明显改善(均P0.05),差异有统计学意义,但两组间各指标治疗前后的差值无统计学意义(P0.05)。结论:对于慢性心力衰竭合并房颤的患者而言,给予抗心力衰竭常规治疗基础上联合上胸段硬膜外阻滞治疗有效,且房颤的存在与否不影响上胸段硬膜外阻滞的疗效。

A Clinical Study on High Thoracic Epidural Anesthesia in the Treatment of Chronic Heart Failure Complicated with Atrial Fibrillation

Objective:To compare the therapeutic effects of high thoracic epidural anesthesia (HTEA) on heart failure patients induced by dilated cardiomyopathy with and without atrial fibrillation.Methods:A total 40 cases of heart failure patients induced by dilated cardiomyopathy were selected and divided into 2 groups: atrial fibrillation AF group and NAF group. All the patients were treated by the heart failure routine medication in addition to HTEA therapy for 4 weeks. The changes of cardiac function NHYA classification, plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD) and Left atrial diameter(LAD) of all patients were compared before and after the treatment.Results:After treatment, the cardiac function NHYA classification, plasma level of NT-proBNP, LVEF, LVEDD and LAD were significantly improved (P<0.05) in boths group compared with those before treatment. But no significant difference was found in the changes of index mentioned above before and after the treatment between AF group and NAF group (P>0.05).Conclusion:The heart failure routine medication in additon to HTEA therapy could be efficiently used for treating chronic heart failure complicated with atrial fibrillation, which was not influenced by complicating with atrial fibrillation.