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目的探讨B超引导下胸2、3椎旁间隙置管连续泵注阻滞在冠心病患者中的应用效果。方法选取2014年8月—2016年1月广州中医药大学深圳医院收治的冠心病患者120例,分为左交感干阻滞组(L组)、右交感干阻滞组(R组)、左交感干无阻滞组(LN组)、右交感干无阻滞组(RN组)4组,每组30例。4组患者均在超声引导下行胸2~3椎旁穿刺置管,L、R组患者镇痛液由罗哌卡因、维生素B12、地塞米松及丹参组成,LN、RN组患者镇痛液无罗哌卡因。记录4组患者治疗前后心电图检查指标、生命体征、心功能指标、血脂指标。结果 (1)4组患者QT间期比较,差异有统计学意义(P<0.05);不同时间点比较,差异无统计学意义(P>0.05);治疗方法与时间在QT间期上存在交互作用(P<0.05)。4组患者校正QT间期、QT离散度比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);治疗方法与时间在校正QT间期、QT离散度上存在交互作用(P<0.05)。(2)4组患者平均动脉压比较,差异无统计学意义(P>0.05);不同时间点比较,差异有统计学意义(P<0.05);治疗方法与时间在平均动脉压上存在交互作用(P<0.05)。4组患者心率、心率与收缩压乘积比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);治疗方法与时间在心率、心率与收缩压乘积上存在交互作用(P<0.05)。(3)4组患者心输出量比较,差异无统计学意义(P>0.05);不同时间点比较,差异有统计学意义(P<0.05);治疗方法与时间在心输出量上存在交互作用(P<0.05)。4组患者冠状动脉直径、左心室射血分数比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);治疗方法与时间在冠状动脉直径、左心室射血分数上存在交互作用(P<0.05)。(4)治疗前4组患者总胆固醇、三酰甘油、低密度脂蛋白比较,差异无统计学意义(P>0.05)。治疗后4组患者总胆固醇比较,差异有统计学意义(P<0.05);三酰甘油、低密度脂蛋白比较,差异无统计学意义(P>0.05)。结论 B超引导下胸2、3椎旁间隙置管连续泵注阻滞在冠心病患者中的应用效果良好,可有效缓解患者临床症状,改善患者心功能。
Objective To investigate the application effect of B-ultrasonography in continuous perfusion of thoracic and paravertebral space in patients with coronary heart disease. Methods A total of 120 CHD patients admitted to Shenzhen University Hospital of Guangzhou University of Chinese Medicine from August 2014 to January 2016 were selected and divided into three groups: left sympathetic trunk block (L group), right sympathetic trunk block (R group), left Sympathetic dry block group (LN group), right sympathetic dry block group (RN group) 4 groups, 30 cases in each group. 4 patients underwent ultrasound-guided chest 2 ~ 3 paraplegia catheterization, L, R patients analgesic by ropivacaine, vitamin B12, dexamethasone and Salvia composition, LN, RN patients with analgesic fluid No ropivacaine. Four groups of patients before and after treatment ECG records, vital signs, cardiac function, blood lipid indicators. Results (1) There was significant difference in QT interval between the four groups (P <0.05), but there was no significant difference at different time points (P> 0.05). There was interaction between treatment time and QT interval (P <0.05). The QT interval and QT dispersion in the four groups were significantly different (P <0.05). The difference was statistically significant at different time points (P <0.05). The treatment methods and time were similar in QT interval, There was interaction on QT dispersion (P <0.05). (2) There was no significant difference in mean arterial pressure between the 4 groups (P> 0.05). There was a significant difference at different time points (P <0.05); there was interaction between the treatment time and mean arterial pressure (P <0.05). The product of heart rate, heart rate and systolic pressure in the four groups had statistical significance (P <0.05), and the difference was statistically significant at different time points (P <0.05). The treatment methods and time had different effects on heart rate, heart rate and systolic blood pressure There is interaction on the product (P <0.05). (3) There was no significant difference in cardiac output between the 4 groups (P> 0.05), and the difference was statistically significant at different time points (P <0.05). There was interaction between the treatment method and time in cardiac output P <0.05). There were significant differences in coronary artery diameter and left ventricular ejection fraction between the 4 groups (P <0.05). The difference was statistically significant at different time points (P <0.05) There was an interaction between left ventricular ejection fraction (P <0.05). (4) There was no significant difference in total cholesterol, triglyceride and low density lipoprotein between the four groups before treatment (P> 0.05). The total cholesterol in the 4 groups after treatment was significantly different (P <0.05). There was no significant difference in triglyceride and low density lipoprotein (P> 0.05). Conclusion B-ultrasound guided thoracic and paravertebral space of 2,3 consecutive perfusion block pump in patients with coronary artery disease with good effect, which can effectively alleviate the clinical symptoms and improve patient’s cardiac function.