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小剂量多巴酚丁胺超声心动图试验的临床研究 |
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方理刚 朱文玲 郭丽琳 倪超 赵云 曾勇
【摘要】 目的 评价小剂量多巴酚丁胺超声心动图试验(LDDE)在急性心肌梗塞早期对心肌梗塞后局部左室功能改善的预测价值。方法 对71例急性心肌梗塞患者于发病后2周内行LDDE, 观察静态、静注多巴酚丁胺(5、10μg*kg-1*min-1)及心梗后3个月局部室壁运动变化。结果 LDDE发现静态时运动减弱节段的心肌存活比无运动节段更常见（分别为50%和15%,P<0.0001,优势比为5.27,95%可信区间为3.02～9.21）。静态时运动减弱节段在随访时局部功能改善比无运动节段更常见（分别为50%和23%,P<0.0001,优势比为3.35, 95%可信区间为1.98～5.67）。以随访时节段局部功能改善作为心肌存活的参考标准, LDDE预测节段局部功能改善总的敏感性、特异性分别为73%、92%。根据LDDE时室壁运动反应分为心肌存活组(A组,31例)及无存活组(B组,40例)。A组随访时室壁运动指数较静态时下降（1.46±0.31降至1.21±0.30, P=0.0016）, B组则无改变。随访时与静态时室壁运动指数差值绝对值A组明显高于B组（分别为0.250±0.012与0.060±0.104, P<0.0001）。结论 LDDE能鉴别急性心肌梗塞后的存活心肌，并能预测左室局部功能的改善，具有较高的特异性，是一种简便和安全的鉴别心肌存活技术。
【关键词】 超声心动描记术 多巴酚丁胺 心肌梗塞
Clinical Study of Low-Dose dobutamine echocardiography Fang Ligang, Zhu Wenling, Guo Lilin, et al. PUMC Hospital, Beijing 100730
【Abstract】 Objective This study was performed to detect viable myocardium using low-dose dobutamine echocardiography (LDDE) and evaluate the role of this method for predicting the improvement of regional left ventricular (LV) function in 71 patients with a first acute myocardial infarction (Q wave) within 2 weeks after onset of acute MI. Methods Regional wall motion was evaluated with 2-dimensional echocardiography at rest, during dobutamine infusion (5,10μg*kg-1*min-1) and that at 3-month follow-up. Results Viability of myocardium detected by LDDE was more frequent in hypokinetic segments than that in akinetic segments (50% vs 15%, P<0.0001,odds ratio ［OR］ 5.27, 95% confidence interval ［CI］ 3.02 to 9.21). Spontaneous recovery of mycar-dium at follow-up was more frequent in hypokinetic segments than that in akinetic segments (50% vs 23%, P<0.0001, OR 3.35, CI 1.98 to 5.67). Sensitivity and specificity of detecting viable segments by LDDE were 73% and 93%, respectively. Myocardial viability in the infarct zone by LDDE was documented in 31 patients(group A) and absent in 40 patients(group B).At follow-[1] [2] 下一页
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