中華超聲影像學(xué)雜志(2000.09).pdf
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·臨床研究·
資助項(xiàng)目:衛(wèi)生部1995 年度優(yōu)秀人才基金(100)
作者單位:100037 北京,中國(guó)醫(yī)學(xué)科學(xué)院心血管病研究所阜外心血
管病醫(yī)院冠心病研究室(胡奉環(huán)、楊躍進(jìn)、尤士杰、高潤(rùn)霜、姚康寶、陳紀(jì)
林、徐義樞、陳在嘉) ,心內(nèi)科(李雪芝、王燕武) ;湖南省郴州市醫(yī)學(xué)�？茖W(xué)
校內(nèi)教研室(劉劍萍)
不同小劑量多巴酚丁胺超聲心動(dòng)圖試驗(yàn)識(shí)別
急性心肌梗死存活心肌的對(duì)比研究
胡奉環(huán) 楊躍進(jìn) 尤士杰 高潤(rùn)霖 劉劍萍 李雪芝 王燕武 姚康寶 陳紀(jì)林 徐義樞 陳在嘉
【摘要】 目的 評(píng)價(jià)不同小劑量[3 ,5 ,和10μg/ (kg· min) ]多巴酚丁胺二維超聲心動(dòng)圖(Dob 22DE)試驗(yàn)識(shí)
別急性心肌梗死(AMI)患者存活心肌的準(zhǔn)確性和安全性,探討 Dob最小有效劑量。方法 AMI患者 31 例,均于梗死后7～14 d行不同小劑量Dob 22DE試驗(yàn),并成功接受了冠狀動(dòng)脈血運(yùn)重建術(shù)(CRV) ,術(shù)后約 6 個(gè)月
復(fù)查2DE。將試驗(yàn)時(shí)檢出存活心肌節(jié)段與 CRV術(shù)后相應(yīng)節(jié)段收縮改善的實(shí)際對(duì)比,計(jì)算識(shí)別存活心肌的準(zhǔn)
確性,評(píng)價(jià)其安全性。結(jié)果 31 例 AMI患者的 221 個(gè)室壁運(yùn)動(dòng)異常節(jié)段中,三種劑量 Dob[ 3 ,5 ,和 10μg/
(kg· min) ] 2DE試驗(yàn)分別檢出 40. 7 %、 50. 2 %和 55. 8 %的存活心肌節(jié)段;識(shí)別存活心肌的敏感性分別為
61. 6 %、 78. 4 %和 89. 4 %,陰性預(yù)測(cè)值及準(zhǔn)確性分別為 63. 4 %、 75. 5 %和 87. 9 %及 72. 4 %、 81. 9 %和 86. 8 %,Dob 3μg/ (kg· min)時(shí)各值均顯著降低( P均< 0. 05 ,0. 001) ,而 Dob 5 和 10μg間除敏感性外均無(wú)顯著差異。
Dob 3 ,5和10μg/ (kg· min)副作用發(fā)生率分別為 0、 12. 9 %和 29. 0 %,特別是Dob 10μg/ (kg· min)時(shí)誘發(fā)心肌
缺血2例(6. 9 %) 。結(jié)論 Dob 10 μg/ (kg· min) 2DE試驗(yàn)識(shí)別 AMI存活心肌最準(zhǔn)確,但欠安全;Dob 3μg/
(kg· min)最安全,但敏感性下降;Dob 5μg/ (kg· min)準(zhǔn)確性和安全性居中,可認(rèn)為是最小有效劑量。
【關(guān)鍵詞】 超聲心動(dòng)描記術(shù);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
小劑量[ 5～10μg/ ( kg· min) ]多巴酚丁胺(Dob)
超聲心動(dòng)圖(2DE)能夠準(zhǔn)確地識(shí)別存活心肌已得到公
認(rèn) ,但其最小有效劑量尚不清楚[1 ,2 ] ......
資助項(xiàng)目:衛(wèi)生部1995 年度優(yōu)秀人才基金(100)
作者單位:100037 北京,中國(guó)醫(yī)學(xué)科學(xué)院心血管病研究所阜外心血
管病醫(yī)院冠心病研究室(胡奉環(huán)、楊躍進(jìn)、尤士杰、高潤(rùn)霜、姚康寶、陳紀(jì)
林、徐義樞、陳在嘉) ,心內(nèi)科(李雪芝、王燕武) ;湖南省郴州市醫(yī)學(xué)�？茖W(xué)
校內(nèi)教研室(劉劍萍)
不同小劑量多巴酚丁胺超聲心動(dòng)圖試驗(yàn)識(shí)別
急性心肌梗死存活心肌的對(duì)比研究
胡奉環(huán) 楊躍進(jìn) 尤士杰 高潤(rùn)霖 劉劍萍 李雪芝 王燕武 姚康寶 陳紀(jì)林 徐義樞 陳在嘉
【摘要】 目的 評(píng)價(jià)不同小劑量[3 ,5 ,和10μg/ (kg· min) ]多巴酚丁胺二維超聲心動(dòng)圖(Dob 22DE)試驗(yàn)識(shí)
別急性心肌梗死(AMI)患者存活心肌的準(zhǔn)確性和安全性,探討 Dob最小有效劑量。方法 AMI患者 31 例,均于梗死后7～14 d行不同小劑量Dob 22DE試驗(yàn),并成功接受了冠狀動(dòng)脈血運(yùn)重建術(shù)(CRV) ,術(shù)后約 6 個(gè)月
復(fù)查2DE。將試驗(yàn)時(shí)檢出存活心肌節(jié)段與 CRV術(shù)后相應(yīng)節(jié)段收縮改善的實(shí)際對(duì)比,計(jì)算識(shí)別存活心肌的準(zhǔn)
確性,評(píng)價(jià)其安全性。結(jié)果 31 例 AMI患者的 221 個(gè)室壁運(yùn)動(dòng)異常節(jié)段中,三種劑量 Dob[ 3 ,5 ,和 10μg/
(kg· min) ] 2DE試驗(yàn)分別檢出 40. 7 %、 50. 2 %和 55. 8 %的存活心肌節(jié)段;識(shí)別存活心肌的敏感性分別為
61. 6 %、 78. 4 %和 89. 4 %,陰性預(yù)測(cè)值及準(zhǔn)確性分別為 63. 4 %、 75. 5 %和 87. 9 %及 72. 4 %、 81. 9 %和 86. 8 %,Dob 3μg/ (kg· min)時(shí)各值均顯著降低( P均< 0. 05 ,0. 001) ,而 Dob 5 和 10μg間除敏感性外均無(wú)顯著差異。
Dob 3 ,5和10μg/ (kg· min)副作用發(fā)生率分別為 0、 12. 9 %和 29. 0 %,特別是Dob 10μg/ (kg· min)時(shí)誘發(fā)心肌
缺血2例(6. 9 %) 。結(jié)論 Dob 10 μg/ (kg· min) 2DE試驗(yàn)識(shí)別 AMI存活心肌最準(zhǔn)確,但欠安全;Dob 3μg/
(kg· min)最安全,但敏感性下降;Dob 5μg/ (kg· min)準(zhǔn)確性和安全性居中,可認(rèn)為是最小有效劑量。
【關(guān)鍵詞】 超聲心動(dòng)描記術(shù);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
小劑量[ 5～10μg/ ( kg· min) ]多巴酚丁胺(Dob)
超聲心動(dòng)圖(2DE)能夠準(zhǔn)確地識(shí)別存活心肌已得到公
認(rèn) ,但其最小有效劑量尚不清楚[1 ,2 ] ......
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