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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P<0.05),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(P>0.05)。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。
Objective: To compare the efficacy of upper thoracic epidural anesthesia in patients with heart failure of dilated cardiomyopathy with and without atrial fibrillation. Methods: Forty patients with heart failure with dilated cardiomyopathy were enrolled, and were divided into atrial fibrillation group and non-atrial fibrillation group according to presence or absence of atrial fibrillation on admission electrocardiogram. All the patients were given thoracic epidural block for 4 weeks on the basis of conventional treatment of heart failure. NYHA functional class, NY-BNP level, Left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVEDD) and left atrium anteroposterior diameter (LAD) changes. Results: Compared with those before treatment, NYHA functional class, NY-BNP, LVEF, LVEDD and LAD were significantly improved in both groups (all P <0.05), but the difference was statistically significant The difference between the index before and after treatment was not statistically significant (P> 0.05). Conclusion: For patients with chronic heart failure complicated by atrial fibrillation, the combination of conventional thoracic epidural block on the basis of routine treatment of anti-heart failure is effective, and the presence or absence of atrial fibrillation does not affect the upper thoracic epidural resistance Hysteresis effect.