Influence of thoracic sympathetic block on patients with diabetes mellitus complicated heart failure / 心血管康复医学杂志

ABSTRACT

Objective: To observe curative effect of thoracic sympathetic block on patients with diabetes mellitus (DM) complicated cardiac chamber enlargement and heart failure (HF). Methods: A total of 76 DM patients with cardiac chamber enlargement and HF were randomly divided into routine treatment group (n=36) and epidural nerve block group (nerve block group, n=40, received thoracic epidural nerve block based on routine treatment), and four weeks were a course of treatment. Changes of left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDd), left atrial diameter (LAD), levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), brain natriuretic peptide (BNP) and glycosylated hemoglobin (HbA1c) were observed in two groups. Results: There were no significant difference in all indexes between two groups before treatment (P>0.05). After treatment, total effective rate of cardiac function improvement in nerve block group was significantly higher than that of routine treatment group (95% vs. 66.7%, P<0.05). Compared with before treatment, there were significant decrease in LVEDd [(71.63±9.26)mm vs. (65.4±8.12)mm] and LAD[(45.62±7.10)mm vs. (37.14 ±6.28)mm] (P<0.05 both), significant increase in LVEF [(31.3±11.46)% vs. (42.12± 10.42) % , P< 0.01], and significant decrease in levels of TNF-α [(73.55±16.36)ng/L vs. (28.35±10.08) ng/L], IL-6 [(17.62±5.47) ng/L vs. (7.88±2.29) ng/L], BNP[(13.49±2.94) ng/L vs. (6.28±2.28) ng/L] and HbA1c [(7.9±2.6) % vs. (6.8±1.9) %] in nerve block group after treatment, P<0.05 or <0.001; and levels of LVEF, TNF-α, IL-6 and BNP in nerve block group after treatment were significantly improved than those of routine treatment group, P<0.05 or <0.01. Conclusion: Thoracic sympathetic block can significantly decrease levels of neuroendocrine and inflammatory factors, improve cardiac function, and elevate quality of life in patients with diabetes mellitus complicated heart failure.