小剂量多巴酚丁胺合用硝酸酯超声心动图识别冬眠心肌

Two dimensional echocardiography with combined low dose dobutamine and nitrate in identifying hiberna ting myocardium

目的评价小剂量多巴酚丁胺（Ｄｏｂｕ）合用硝酸异山梨酯（异舒吉）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（３～５μｇ·ｋｇ－１·ｍｉｎ－１）合用异舒吉（２４０～３００μｇ／ｍｉｎ）２ＤＥ试验，并成功进行了冠状动脉血运重建术（ＣＲＶ），术后３个月左右完成２ＤＥ随访。用１６节段半定量法分析各节段收缩运动和增厚情况并予分级和计分。将该试验检出的冬眠心肌节段与ＣＲＶ术后其收缩功能改善的实际对比，计算出识别冬眠心肌的准确性，并评价其安全性。结果在１２２个异常节段中，小剂量Ｄｏｂｕ合用异舒吉２ＤＥ检出了６７２％～６８０％的冬眠心肌节段，与ＣＲＶ术后对比识别冬眠心肌的敏感性，特异性和准确性分别为８４６％～８５７％，８３．９％和８４４％～８５３％。副作用轻。结论小剂量Ｄｏｂｕ合用异舒吉２ＤＥ试验是识别冬眠心肌的准确方法。

Objective To evaluate the accuracy and safety of two dimensional echocardiography (2DE) with combined low dose dobutamine (Dobu) and Isoket (intravenous agent of Isosorbide dinitrate, Schwarz Pharma AG.) in identifying hibernating myocardium. Methods 2DE with combined low dose (3 and 5 μg·kg -1 ·min -1 ) Dobu and Isoket (mean of 294.8±17.3 μg/min) was done in 23 patients with old myocardial infarction (OMI) who were scheduled to undergo coronary revascularization (CRV). CRV included successful, coronary angioplasty in 17 and coronary bypass surgery in 6 and the follow up 2DE was done about 3 months after CRV. By using a 16 segment model and semiquantitative analysis method, the left ventricular regional wall motion and thickening in each segment was graded and scored. The hibernating myocardium segments detected were compared with the actual post CRV functional improvement of the corresponding segments to calculate the sensitivity, specificity and accuracy of the test in identifying hibernating myocardium. The safety of the test was also assessed. Results Among 122 abnormal segments in the 23 patients with OMI, hibernating myocardium segments were detected by low dose Dobu combined with Isoket 2DE test in 67.2%～68.0%. The sensitivity, specificity and accuracy of the test in identifying hibernating myocardium were 84.6%～85.7%, 83.9% and 84.4%～85.3% respectively. The side effects of the test were mild with 10 cases (43.5%) feeling palpitation and headache. No myocardial ischemia and hypotension occurred. Conclusion The low dose Dobu combined with Isoket (240～300 μg/min) 2DE is accurate for identifying hibernating myocardium, and it is safe due to the anti ischemic effect of Isoket and the low dose of Dobu.