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、１０μｇ·ｋｇ－１·ｍｉｎ－１）各剂量组间差异均无显著性，但已与Ｄｏｂｕ１０μｇ·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Ｄｏｂｕ５μｇ·ｋｇ－１·ｍｉｎ－１合用硝酸酯时已达单用Ｄｏｂｕ１０μｇ·ｋｇ－１·ｍｉｎ－１时的水平（６６．３％ｖｓ７４．６％，Ｐ＞０．０５），而又无Ｄｏｂｕ１０μｇ·ｋｇ－１·ｍ?
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 tests, 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 )
出处
《中华心血管病杂志》
CSCD
北大核心
1998年第6期432-435,共4页
Chinese Journal of Cardiology
基金
195年卫生部优秀人才基金
196年卫生部科学基金
关键词
心肌顿抑
超声心动图
多巴酚丁胺
硝酸酯
myocardium stunning
echocardiography
isosorbide dinitrate
dobutamine
