多巴酚丁胺负荷前后核素心室造影对冠心病的诊断价值

DIAGNOSTIC VALUE OF RADIONUCLIDE VENTRICULOGRAPHY BEFORE AND AFTER DOBUTAMINE-STRESSING IN CORONARY ARTERY DISEASES

目的 :药物负荷前后核素心室造影已成为诊断冠心病的重要手段 ,特别适用于一些不宜运动的患者 ,采用多巴酚丁胺负荷前后核素心室造影对其诊断冠心病的效能进行评价。方法 :静脉注射多巴酚丁胺以 5μg· kg- 1 · min- 1 的起始浓度开始 ,每 3 min递增 5μg· kg- 1 直至 3 0μg· kg- 1 · min- 1 或出现终止指标即停止。负荷高峰时开始采集 ,可以 5μg· kg- 1 · m in- 1 剂量维持心率至采集结束。结果 :多巴酚丁胺负荷前后以 L VSDP(左室峰相位标准差 )增值大于 8度 ,REF增值小于 10 %作为诊断冠心病的标准 ,诊断的灵敏度和特异性负荷前为 87%和 83 % ,负荷后为 89%和 81% ,其诊断的灵敏度和特异性相近 ,较 L VEF、PFR等参数为佳。如果将L VSDP和 REF结合分析 ,其诊断冠心病的灵敏度和特异性可提高至 89%和 86%。结论 :多巴酚丁胺负荷前后核素心室造影是安全、有效、无创的冠心病辅助诊断手段 ;对于冠心病心肌缺血的诊断 。

Objective:To evaluate the diagnostic value of dobutamine loaded nuclear ventriculography in coronary artery disease(CAD);Methods:Fifty nine cases and 26 controls were treated.Dobutamine injection was given iv with an initial dose of 5 μg·kg -1 ·min -1 ,then each 5 μg·kg -1 was increased every 3 min until the end dose up to 30 μg·kg -1 ·min -1 ,or the peak of dobutamine stress appeared.Results:Either before or after dobutamine stressing took LVSDP(left ventricular standard deviation of peak)increment over 8°,and REF (ejection fraction at rest)below 10% as the criterion for diagnosing CAD.Sensitivity and specificity of blood pool imaging before dobutamine stressing were 87% and 83%,those after dobutamine stressing were 89% and 81%,Parameters of LVSDP and REF used for CAD diagnosis were better than those of LVEF(left ventricular ejection fraction) and PFR(peak filling rate).A combination analysis of LVSDP with REF can raise the sensitivity and specificity for CAD diagnosis up to 89% and 86%,Conclusion:Dobutamine loaded radionuclide ventriculography is safe,effective,and noninvasive;it can be used as an auxiliary diagnostic method for CAD.For the diagnosis of myocardial ischemia,it is the local parameter of heart function that plays a better role than a total one of the heart.