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小剂量多巴酚丁胺及其合用硝酸酯超声心动图试验识别冬眠心肌的对比研究 |
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杨跃进 高润霖 田军 尤士杰 徐义枢 陈在嘉 武玉兰 王燕武
【摘要】 目的 对比小剂量多巴酚丁胺(Dobu)及其合用硝酸酯二维超声心动图(2DE)试验识别冬眠心肌的准确性和安全性。方法 陈旧性心肌梗塞患者23例，行小剂量Dobu及其合用硝酸酯试验后成功接受了冠状动脉血运重建术(CRV)，术后3个月左右复查2DE。用16-段半定量分析法对左室各节段收缩运动和增厚情况给予分级记分。将两试验检出的冬眠心肌节段与CRV术后相应节段收缩改善的实际对比，计算识别冬眠心肌的准确性。比较血运重建术前后两试验的结果，并评价安全性。结果 小剂量(3、5μg*kg-1*min-1)Dobu合用硝酸酯试验识别冬眠心肌的敏感性、特异性和准确性分别为85%～86%、84%和84%～85%，虽与单用Dobu(3、5、10 μg*kg-1*min-1)各剂量组间差异均无显著性，但已与Dobu 10μg*kg-1*min-1的86%、80%和85%相当；且使冬眠心肌收缩改善2分节段百分比显著高于同剂量Dobu单用时(P均<0.05)，尤其在Dobu 5μg*kg-1*min-1合用硝酸酯时已达单用Dobu 10μg*kg-1*min-1时的水平(66.3% vs 74.6%，P>0.05)，而又无Dobu 10μg*kg-1*min-1诱发心肌缺血的副作用。结论 小剂量(3、5μg*kg-1*min-1) Dobu-硝酸酯2DE试验比单用Dobu时使冬眠心肌收缩作用更强、又更安全，是识别冬眠心肌较为理想而可靠的方法。
【关键词】 心肌顿抑 超声心动描记术 亚硝酸异三梨醇酯 多巴酚丁胺
Comparison of low-dose dobutamine and its combination with nitrate echocardiography in identifying hibernating myocardium
Yang Yuejin, Gao Runlin, Tian Jun, et al. Cardiovascular Institute and Fu Wai Heart Hospital, CAMS and PUMC, Beijing 100037
【Abstract】 Objective To compare the accuracy and safety of low-dose dobutamine (Dobu) and its combination with nitrate two -dimensional echocardiography (2DE) in identifying hibernating myocardium.Methods Low-dose (3,5and 10μg*kg-1*min-1) Dobu (Dobu-3,5 and 10) and combined low-dose (3 and 5μg*kg-1*min-1) Dobu (Dobu-3 and 5) with isosorbide dinitrate (ISDN, 240-300μg*min-1) 2DE tests were conducted in 23 patients with old myocardial infarction who were scheduled to undergo coronary revascularization (CRV). CRV was successful in all patients including angioplasty of 17 and bypass surgery of 6, and the follow-up 2DE were also done about 3 months after CRV. Left ventricular regional wall motion and thickening in each segment were graded and scored using a 16-segment model and semiquantitative analysis method. The detected hibernating myocardium, defined as 1 or 2 scores decreasing in at least two adjacent abnormal segments after the two t[1] [2] [3] 下一页
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