美托洛尔在多巴酚丁胺-阿托品负荷超声心动图检测冠心病中的应用价值  

Value of metoprolol injection at dobutamine-atropin stress echocardiography for detection of coronary artery disease

作　　者：姚静[1] 陆凤翔[1] 许迪[1] 周蕾[1] 雍永宏[1] 徐兢[1] 唐晓霞[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029

出　　处：《中华心血管病杂志》2005年第10期889-893,共5页Chinese Journal of Cardiology

摘　　要：目的评价美托洛尔静脉注射在多巴酚丁胺-阿托品负荷超声心动图(DASE)检测冠心病(CAD)中的应用价值。方法选择可疑CAD患者72例,在DASE检查达负荷心率后快速静脉注射美托洛尔(DASE-Meto),DASE-Meto检查后2周内行冠状动脉造影(CAG)。分析DASE负荷心率时及美托洛尔静脉注射后室壁运动计分指数及血流动力学参数,将CAG结果与DASE、DASE-Meto结果进行比较分析。结果CAG阳性患者35例,阴性37例。DASE检测CAD的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为65.7%、86.5%、76.4%、82.1%、84.6%,10例CAG阳性患者DASE负荷心率时为阴性,而在美托洛尔注射后出现节段性室壁运动障碍,故DASE-Meto检测的CAD的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为94.3%、83.8%、88.9%、72.7%、93.9%。美托洛尔静脉注射后,使用多巴酚丁胺、阿托品所致不良反应减轻,恢复时间缩短。结论在DASE负荷心率时静脉注射美托洛尔可提高检测CAD的准确性、安全性。Objective To investigate the value of metoprolol injection at dobutamine-atropin stress echocardiography（DASE） for detection of coronary artery disease （CAD）. Methods DASE was performed in 72 patients with suspected CAD. All the patients received rapid metoprolol injection immediately after getting peak heart rate at DASE（DASE-Meto） and were subjected to coronary angiography（CAG） within two weeks. Reg/onal wall motion and haemodynamic parameters at peak heart rate during DASE and after metoprolol injection were analyzed, and DASE and DASE-Meto results were compared with CAG. Results There were 35 patients with CAG positive and 37 negative. The sensitivity, specificity, accuracy and positive and negative predictive values of DASE for detecting CAD were 65.7%, 86. 5%, 76. 4%, 82. 1% and 84. 6% , respectively. There were 10 patients with positive result at CAG undetected by DASE but observed regional wall motion abnormality （RWMA） after metoprolol injection. So the sensitivity, specificity, accuracy and positive and negative predictive values of DASE-Meto for detecting CAD were 94. 3%, 83.8%, 88.9% , 72. 7%, 93.9% , respctively. After metoprolol injection, the symptoms caused by the medicine used in detection were alleviated soon and recovery time was shortened. Conclusion The use of metoprolol at DASE can improve the accuracy and security of CAD detection.

关 键 词：冠状动脉疾病 美托洛尔 超声心动描记术 压力 

分 类 号：R541.4[医药卫生—心血管疾病] R842[医药卫生—内科学]