正性肌力药物多巴酚丁胺对左心室运动同步性的影响

Effect of inotropic agent dobutamine on left ventricular synchronism

目的探讨正性肌力药物多巴酚丁胺对左心室运动同步性的影响。方法59例可疑或确诊冠心病的患者,分为多巴酚丁胺负荷试验组(DSE)(n=26)和腺苷负荷试验组(ASE)(n=33),采用药物负荷试验超声心动图技术,以左心室12个节段(6个基底节段和6个中间节段)及6个基底节段收缩期速度达峰时间(Ts)和舒张早期速度达峰时间(Te)的变异系数(Ts-CV、Te-CV)作为评价左心室整体收缩期和舒张期不同步的指标。结果基线状态下,DSE组与ASE组12节段Ts-CV比较无统计学差异(P>0.05);达到峰值剂量后,与ASE组比较,DSE组12节段和6基底节段Ts-CV均显著增加,分别为(33±17)%vs(24±10)%(P<0.05)和(32±20)%vs(22±10)%(P<0.01);12节段和6基底节段Te-CV亦显著增加,分别为(14±10)%vs(5±3)%(P<0.01)和(13±12)%vs(5±3)%(P<0.01)。结论正性肌力药物多巴酚丁胺对左心室运动同步性具有负性作用,不适用于慢性心力衰竭患者的长期治疗。提示药物对心脏同步性的作用值得深入研究。

Objective To evaluate the effect of dobutamine, an inotropic agent on left ventricular （LV） synchronism. Methods Fifty-nine patients suspected or confirmed of coronary heart disease were divided into dobutamine stress experiment group（ DSE group, n =26） and adenosine stress experiment group （ASE group, n =33）. Using pharmacological stress echocardiography protocols, the coefficient of variation （CV） of time to peak systolic velocity （Ts） （Ts-CV） and peak early diastolic velocity （Te） （Te-CV） were served as indexes of dyssynchronism in both 12 segments （6 basal and 6 mid segments） and only 6 basal segments of LV. Results There was no significant difference in Ts-CV of 12 segments between DSE group and ASE group at the baseline（P 〉0.05）. Compared with ASE group, both Ts-CV of 12 and 6-basal segments at the peak dosage stage in DSE group were significantly increased, （33 ± 17） % vs （24 ± 10） % （ P 〈 0.05） and （32 ±20）% vs （22 ±10）% （P 〈0.01） , respectively. And Te-CV of 12 and 6-basal segments at the peak dosage stage were also significantly increased in DSE group, （14±10）% vs （5±3）% （P〈0.01） and （13±12）% vs （5 ±3）% （P 〈0.01） , respectively. Conclusion Dobutamine, an inotropic agent, has negative effect on LV synchronism, which indicates that it may not be suitable for long-term use in chronic heart failure and suggests that studies on effects of medications on LV synchronism should be conducted.