·临床研究·

    资助项目:卫生部1995 年度优秀人才基金(100)

    作者单位:100037 北京,中国医学科学院心血管病研究所阜外心血

    管病医院冠心病研究室(胡奉环、杨跃进、尤士杰、高润霜、姚康宝、陈纪

    林、徐义枢、陈在嘉) ,心内科(李雪芝、王燕武) ;湖南省郴州市医学专科学

    校内教研室(刘剑萍)

    不同小剂量多巴酚丁胺超声心动图试验识别

    急性心肌梗死存活心肌的对比研究

    胡奉环 杨跃进 尤士杰 高润霖 刘剑萍 李雪芝 王燕武 姚康宝 陈纪林 徐义枢 陈在嘉

    【摘要】 目的 评价不同小剂量[3 ,5 ,和10μg/ (kg· min) ]多巴酚丁胺二维超声心动图(Dob 22DE)试验识

    别急性心肌梗死(AMI)患者存活心肌的准确性和安全性,探讨 Dob最小有效剂量。方法 AMI患者 31 例,均于梗死后7～14 d行不同小剂量Dob 22DE试验,并成功接受了冠状动脉血运重建术(CRV) ,术后约 6 个月

    复查2DE。将试验时检出存活心肌节段与 CRV术后相应节段收缩改善的实际对比,计算识别存活心肌的准

    确性,评价其安全性。结果 31 例 AMI患者的 221 个室壁运动异常节段中,三种剂量 Dob[ 3 ,5 ,和 10μg/

    (kg· min) ] 2DE试验分别检出 40. 7 %、 50. 2 %和 55. 8 %的存活心肌节段;识别存活心肌的敏感性分别为

    61. 6 %、 78. 4 %和 89. 4 %,阴性预测值及准确性分别为 63. 4 %、 75. 5 %和 87. 9 %及 72. 4 %、 81. 9 %和 86. 8 %,Dob 3μg/ (kg· min)时各值均显著降低( P均< 0. 05 ,0. 001) ,而 Dob 5 和 10μg间除敏感性外均无显著差异。

    Dob 3 ,5和10μg/ (kg· min)副作用发生率分别为 0、 12. 9 %和 29. 0 %,特别是Dob 10μg/ (kg· min)时诱发心肌

    缺血2例(6. 9 %) 。结论 Dob 10 μg/ (kg· min) 2DE试验识别 AMI存活心肌最准确,但欠安全;Dob 3μg/

    (kg· min)最安全,但敏感性下降;Dob 5μg/ (kg· min)准确性和安全性居中,可认为是最小有效剂量。

    【关键词】 超声心动描记术;多巴酚丁胺;心肌梗塞;存活心肌

    Comparison of different low dose dobutamine echocardiography for identifying viable myocardium in patients with

    acute myocardial infarction HU Fenghuan

    3

    , YANG Yuejin , YOU S hijie , et al .

    3

    Department of coronarg Heart

    Disease Cardiovascular Institute and Fuwai Heart Ho spital , CAMS and PUMC, Beijing 100037 , China

    【Abstract】 Objective To evaluate the accuracy and safety of different low2dose [3 ,5 and 10μg/ (kg· min) ]

    dobutamine (Dob) two2dimensional echocardiography (2DE) for detecting viable myocardium, and to seek an optimal dose

    of Dob for chinese patients with acute myocardial infarction(AMI ) .Methods In 31 patients with AMI who were scheduled

    to undergo coronary revascularization (CRV) , low2dose [3 ,5 and 10μg/ (kg· min) ] Dob 22DE tests were conducted 1～2

    weeks [ (10± 3) days] after the infarction. CRV was successful in all patients , and the follow 2up 2DE were also done about

    5～6 months after CRV. The detected viable myocardium after the tests were com pared with the post2CRV actual

    contractile improvement of corres ponding segments to calculate the sensitivity , specificity , positive and negative predictive

    value (PPV and NPV) and accuracy of the tests for identifying viable myocardium. The safety of these tests were also

    evaluated.Results Among 221 abnormal segments in 31 patients with AMI , the rates of viable myocardial segments

    detected by Dob 3 ,5 and 10μg/ (kg· min) 2DE tests were 40. 7 %,50. 2 %and 55. 8 %, respectively , which in Dob 5 and

    10μg/ (kg· min) were significantly higher than that in Dob 3μg/ (kg· min) (both P < 0. 05) . The sensitivity of low2dose

    [3 ,5 and 10μg/ (kg· min) ] Dob 2DE tests for the identifying viable myocardium were 61. 6 %,78. 4 % and 89. 5 %,res pectively. There were significant differences between each two dosage ( P < 0. 01 ,0. 001) . The NPV were 63. 4 %,75. 5 % and 86. 8 %, and accuracy 72. 4 %, 81. 9 % and 87. 9 %, respectively , with those in Dob 5 and 10μg/ (kg· min)

    being significantly higher than those in Dob 3μg/ (kg· min) ( P < 0. 01 ,0. 001) . On the other hand , the rates of side

    effects in 3 , 5 and 10μg were 0 , 12. 9 %and 29. 0 %, res pectively. Myocardial ischemia had been induced by Dob 10μg/

    (kg· min) in 2 cases (6. 9 %) . Conclusions For identifying viable myocardium with different low 2dose [3 ,5 and 10μg/

    (kg· min) ] Dob 2DE test in patients with AMI , Dob 10μg/ (kg· min) is the most accurate though less safe , Dob 3μg/

    (kg· min) is safest but less sensitive , and Dob 5μg/ (kg· min) may be an optimal dose for Chinese ,which is more sensitive

    and accurate than Dob 3μg/ (kg· min) and safer than Dob 10μg/ (kg· min) .

    【Key words】 Echocardiography ;Dobutamine ;Myocardial infarction ;Viable myocardium

    小剂量[ 5～10μg/ ( kg· min) ]多巴酚丁胺(Dob)

    超声心动图(2DE)能够准确地识别存活心肌已得到公

    认 ,但其最小有效剂量尚不清楚[1 ,2 ] ......