摘要
目的 对比硝酸酯、小剂量多巴酚丁胺 (Dob)及其合用二维超声心动图 (2DE)试验识别急性心肌梗死 (AMI)存活心肌的准确性和安全性。方法 AMI患者 31例 ,于发病后 7～ 14(10± 3)d行硝酸酯、小剂量Dob及其合用 2DE试验 ,后行冠状动脉血运重建 (CRV)术成功 ,术后 6个月左右(16 7± 18)d复查 2DE。用 16节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 2DE试验所检的存活心肌与CRV术后其收缩功能改善的实际对比 ,评价识别AMI存活心肌的准确性和安全性。结果 31例AMI患者共有 2 2 1个异常节段。与硝酸酯和Dob 3μg单用时相比 ,两者合用 2DE试验对AMI区存活心肌节段的检出率均显著提高 (5 0 .2 %对 37.6 %和 40 .7% ,P均 <0 .0 5 ) ,识别敏感性和准确性也均显著提高 (77.6 %对 5 6 .8%和 6 1.6 % ,81.0 %对 70 .1%和 72 .4% ,P <0 .0 5～0 0 1) ;而硝酸酯合用Dob 5 μg 2DE试验对存活心肌的检出率、识别敏感性和准确性均已达Dob 10 μg单用时的水平 (5 5 .7%对 5 5 .8% ,87.2 %对 89.5 %和 86 .4%对 87.9% ,P均 >0 .0 5 ) ,而又无Dob 10 μg诱发心肌缺血的副作用。结论 硝酸酯与小剂量 (3、5 μg·kg-1·min-1)Dob合用 2DE试验比两者单用时能提高识别AMI存活心肌的敏感性和准确性 。
Objective To compare the accuracy and safety of nitrate, low dose dobutamine and combination of echocardiography for identifying viable myocardium in patients with acute myocardial infarction (AMI). Methods Isosorbide dinitrate (286.5±25.5 μg/min), low dose dobutamine (3, 5 and 10 μg·kg -1 ·min -1 ) alone and combined isosobide dinitrate with low dose dobutamine (3 and 5 μg·kg -1 ·min -1 ) two dimensional (2 D) echocardiography tests were performed at 7 14 (10±3) days after AMI in 31 patients scheduled for coronary revascularization (CRV). CRV was successful in all patients and follow up 2 D echocardiography was conducted at 6 months (mean 167±18 days) after CRV. Using 16 segment model and 5 grading method, the left ventricular regional wall motion and thickening was graded and scored. The detected viable myocardium, defined as ≥1 scores decreasing in at least two adjacent abnormal segments after the tests, were compared with the post CRV actual contractile improvement of corresponding segments to calculate sensitivity, specificity and accuracy of the tests for identifying viable myocardium. The safety of the tests were also evaluated. Results There were total of 221 abnormal segments in 31 patients with AMI. Compared with isosorbbide dinitrate and dobutamine 3 μg·kg -1 ·min -1 alone, combined isosorbide, dobutamine 3 μg·kg -1 ·min -1 2 D echocardiography detected more viable myocardium segment (50.2% vs 37.6% and 40.7%, both P <0.05), and had significantly higher sensitivity and accuracy (77 6% vs 56.8% and 61.6%, 81.0% vs 70.1% and 72.4%, P <0.05～0 01). The viable myocardial segment detecting rate, sensitivity and accuracy of combined isosorbide dinitrate, dobuyamine 5 μg·kg -1 ·min -1 2 D echocardiography were all equivalent to those of dobutamine 10 μg·kg -1 ·min -1 alone (55.7% vs 55.8%, 87.2% vs 89.5%, 86.4% vs 87.9%, all P >0.05), but did not induce ischemia. ConclusionCombined nitrate with low dose (3
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2001年第1期25-28,共4页
Chinese Journal of Cardiology
基金
卫生部 1996年科学基金资助 (编号 :96 10 0 )
