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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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ests, were compared with the post-CRV actual contractile improvement of corresponding segments to calculate the sensitivity, specificity and accuracy of the tests for identifying hibernating myocardium. Comparison was also made between the two tests.Results The sensitivities, specificities and accuracies of Dobu-nitrate 2DE for identifying hibernating myocardium were 85-86%, 84% and 84-85%, respectively, which were not significantly different from those of different low dose Dobu tests, though were equivalent to 86%,80% and 85%, respectively of Dobu -10 alone. The percentages of marked (2 scores) contractile improving segments among detected hibernation segments on Dobunitrate tests were significantly higher than those on the same dose of Dobu tests (both P<0.05); particularly with the percentages on combined Dobu-5 with nitrate being equivalent to that on Dobu-10 alone (66.3% vs 74.6%, P>0.05), and without occurrence of ischemia as induced by Dobu-10. Conclusion Combined low-dose (3-5 μg*kg-1*min-1) Dobu with nitrate 2DE test is more prominent in strengthening the contractility of hibernating myocardium for detection and safer than the same dose Dobu test alone, indicating a relatively reliable and ideal method for identifyfing hibernating myocardium.
【Key words】 myocardium stunning echocardiography isosorbide dinitrate dobutamine
小剂量(5～10μg*kg-1*min-1)多巴酚丁胺(Dobu)二维超声心动图(2DE)试验是识别冬眠心肌的可靠方法已得到公认［1，2］。本研究旨在对比小剂量Dobu及其合用硝酸酯的2DE试验识别冬眠心肌的准确性和安全性。
资料与方法
一、病例选择
陈旧性心肌梗塞患者23例，均在完成小剂量Dobu及其合用硝酸酯2DE试验后2周内成功地接受了包括梗塞相关冠状动脉(IRCA)在内的冠脉血运重建术(coronary revascularization,CRV),其中球囊扩张或支架置入17例，外科冠状动脉旁路移植术6例。23例中，男22例，女1例，平均年龄51.6±10.8岁；梗塞部位：前、侧壁8例，下、后壁14例，前壁＋下壁1例，心功能均为NYHA II级。左室造影均有室壁节段运动异常(RWMA)存在，平均射血分数为54.6±10.3%; 冠状动脉造影显示单支病变(冠脉内径狭窄≥50％)8例，双支病变8例，3支病变7例；IRCA的病变狭窄约80% 1例，约90%～95% 13例, 99%～100% 9例。
二、方法
1.小剂量Dobu及其合用硝酸酯2DE试验：患者先停用β-受体阻滞剂、钙拮抗剂和硝酸酯类至少18小时。然后，在安静状态下测心率、血压取三次均值；用惠上一页 [1] [2] [3] 下一页
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