彩色室壁运动小剂量多巴酚丁胺负荷试验检测存活心肌的研究

Clinical study of low-dose dobutamine stress echocardiography with color kinesis for detecting viable myocardium

目的 探讨彩色室壁运动小剂量多巴酚丁胺负荷试验 (CK LDDE)检测存活心肌的应用价值。方法 心肌梗死患者 32例 ,经CK LDDE(多巴酚丁胺剂量 5～ 10 μg·kg-1·min-1)检查后 1周成功行经皮经腔冠状动脉成形术 (PTCA)。以PTCA术后 1月CK图像与术前静息CK图像比较 ,节段室壁运动改善≥ 1级或心内膜位移≥ 2mm作为存活心肌的诊断标准。结果 CK LDDE检测存活心肌的敏感性、特异性和准确性分别为96 %、80 %和 88% ;运动减弱节段较运动丧失节段的存活心肌多 ( 82 %vs 34% ,P <0 .0 1) ,反向运动节段无存活心肌。结论 CK LDDE能准确地检出心肌梗死后存活心肌 ,为临床诊断和选择治疗提供可靠依据。

Objective To evaluate the value of color kinesis low dose dobutamine stress echocardiography (CK LDDE) in detecting viable myocardium.Methods Thirty two patients with myocardium infarction underwent CK LDDE using incremental doses of 5～10 μg·kg -1 ·min -1 in every 5 minutes continuously before successful PTCA.An infarct zone was judged to have viable myocardium (comparing with base line) when wall motion improved ≥1 grade or segmental endocardial motion (SEM)≥2 mm in at least one asynergic segments.Results The sensitivity,specificity and accuracy of CK LDDE in predicting viable myocardium were 96%,80% and 88%,respectively.The viable myocardium in hypokinesia was more than those in akinesia (82% vs 34%,P< 0.01 ).There were not viable myocardium in dyskinesia.Conclusions CK LDDE has high value in detecting viable myocardium,and it can provide reliable proof for selecting remedy.