CT引导下胸交感神经阻滞治疗甲亢所致心力衰竭的价值探讨

陈思+周忠

[摘要] 目的 探討CT引导下胸交感神经阻滞治疗甲亢所致心力衰竭的临床价值。方法 选择2013年3月～2015年12月收治的甲亢所致心力衰竭患者80例，对照组（n=40）采用常规治疗，观察组（n=40）在对照组基础上联合使用CT引导下胸交感神经阻滞，比较两组治疗前后血浆肾上腺素（E）、去甲肾上腺素（NE）和B型利钠肽（BNP）水平，治疗后24 h心率变异时域指标和治疗前后心功能相关指标。结果 治疗后两组BNP、E及NE水平均低于治疗前（P均<0.05），治疗后，观察组BNP、E及NE水平均低于对照组（P均<0.05）；治疗后，观察组SDNN、SDANN和RMSSD均长于对照组（P均<0.05），PNN50大于对照组（P<0.05）；治疗后两组左心室内径、左心室射血分数和心胸比明显优于治疗前（P均<0.05）；治疗后观察组左心室内径、左心室射血分数和心胸比明显优于对照组（P均<0.05），观察组心衰超声指数显著低于对照组（P<0.05）。结论 CT引导下胸交感神经阻滞治疗甲亢所致心力衰竭能显著降低交感神经兴奋性，降低体内儿茶酚胺类激素水平，改善心脏功能。

[关键词] 胸交感神经阻滞；CT引导；甲状腺功能亢进；心力衰竭

[中图分类号] R542.2 [文献标识码] A [文章编号] 1673-9701（2017）07-0012-04

[Abstract] Objective To investigate the clinical value of CT-guided thoracic sympathetic nerve block in the treatment of heart failure caused by hyperthyroidism. Methods A total of 80 patients with heart failure caused by hyperthyroidism from March 2013 to December 2015 were selected. The control group （n=40） was treated with conventional therapy. The observation group （n=40） was used CT-guided thoracic sympathetic nerve block on the basis of the control group. Plasma epinephrine （E）， norepinephrine （NE） and B-type natriuretic peptide （BNP） levels between the two groups before and after treatment were compared. Heart rate variability time-domain index at 24 hours after treatment and function-related indicators were compared between the two groups before and after treatment. Results The levels of BNP， E and NE after treatment were lower than those before treatment in the two groups（P<0.05）. After treatment， the levels of BNP， E and NE in the observation group were lower than those in the control group （P<0.05）. And SDNN， SDANN and RMSSD in the observation group were longer than those in the control group after treatment（P<0.05）. PNN50 in the observation group was higher than that in the control group after treatment （P<0.05）. The left ventricular diameter， left ventricular ejection fraction and cardiac ratio in two groups after treatment were significantly better than those before treatment （P<0.05）. And the left ventricular diameter， left ventricular ejection fraction and cardio/thoracic ratio in the observation group were significantly better than those in the control group after treatment （P<0.05）. The ultrasonographic index of the heart failure in the observation group was significantly lower than that of the control group（P<0.05）. Conclusion CT-guided thoracic sympathetic nerve block in the treatment of heart failure caused by hyperthyroidism can significantly reduce the excitability of sympathetic nerve and the level of catecholamines in the body， and can improve the cardiac function.

[Key words] Thoracic sympathetic nerve block； CT-guided； Hyperthyroidism； Heart failure

甲状腺功能亢进患者主要临床表现为机体基础代谢率增加，心率增快是较常见表现，随着病程的延长以及合并心血管危险因素等诱因时将发生心力衰竭，此时机体出现交感神经兴奋性增强与分布异常、神经生长因子再生、交感神经重构等。一旦发生心力衰竭，首先引起支配心脏的交感/副交感神经功能失衡[1]，出现冠状动脉阻力增加、血小板聚集，进而出现血栓形成、心肌灌注降低、缺血再灌注损伤和心肌细胞内钙离子超载，导致心脏电稳定性降低，诱发恶性心律失常甚至导致患者猝死。

近年来基础与临床研究均证实，降低心脏交感神经兴奋、长期保持低强度的迷走神经刺激，能有效改善急性心肌梗死患者左心室功能，提高疾病预后，有部分学者将其应用于治疗重度心力衰竭[2-3]。本研究主要探讨CT引导下胸交感神经阻滞治疗甲亢所致心力衰竭的临床价值，现报道如下。……