多巴酚丁胺对心肌桥-壁冠状动脉血流动力学的作用  

The hemodynamic effect of dobutamine stress on myocardial bridging-mural coronary artery

作　　者：张国辉[1] 郭俊芳[1] 真亚[1] 李卫东[1] 鲍中华[1] 姜红[1] 钱菊英[2] 樊冰[2] 葛均波[2] 

机构地区：[1]江苏省镇江市第一人民医院心内科,212002 [2]上海中山医院心内科

出　　处：《中华心血管病杂志》2006年第10期899-901,共3页Chinese Journal of Cardiology

摘　　要：目的探讨运动对心肌桥患者血流动力学的影响。方法观察8例心肌桥患者在静脉滴注多巴酚丁胺前后壁冠状动脉受压程度的变化,并运用腔内多普勒技术观察壁冠状动脉的基础峰值血流速率(bAPV)、最大峰值血流速率(hAPV)、冠状动脉血流储备(CFR)的变化。结果多巴酚丁胺使壁冠状动脉受压程度由用药前的平均(51.7±21.4)%增加至(90.0±12.7)%,P<0.01;壁冠状动脉近段和远段的 hAPV 分别由(19.83±5.84)cm/s 和(20.75±4.91)cm/s 增加至(31.52±10.93)cm/s 和(30.46±9.01)cm/s;壁冠状动脉近段和远段的 CFR 分别由(2.91±0.62和2.46±0.82,P<0.05)下降至(2.17±0.66和1.83±0.51,P 均<0.01)。结论运动可能使壁冠状动脉受压程度增加,CFR 显著下降。Objective Patient with myocardial bridging （MB） usually has a benign prognosis, but some MB patients might experience myocardial ischemia, infarction and sudden cardiac death, especially during active physical activities. The purpose of the study was to study the stress-induced blood flow changes of the mural coronary artery in MB patients determined by intracoronary Doppler. Methods In 8 patients with MB, the basic average peak velocity （bAPV）, hyperemic average peak velocity （hAPV） of blood flow, coronary flow reverse （CFR） proximal and distal to the mural coronary artery were measured before and during intravenously dobutamine （10 μg· kg^-1· min^-1 ,then add 10 μg· kg^-1· min^-1 at 3 min interval till 40 μg· kg^-1· min^-1） by intracoronary Doppler. Results The baseline mural coronary diameter reduction was （51.7 ± 21.4）% and significantly increased to （90.0 ± 12.7）% （P 〈 0.01） during dobutamine infusion, bAPV on the segments proximal and distal to the mural coronary artery significantly increased from （ 19. 83± 5.84） cm/s and （20. 75 ± 4. 91 ） cm/s to （31.52 ±10. 93 ） cm/s and （ 30. 46 ± 9.01 ） cm/s （all P 〈0. 05 vs. baseline） respectively post dobutamine infusion. CFR measured at proximal and distal to myocardial bridging also significantly decreased from （ 2. 91 ±0. 62 ） and （ 2. 46 ±0. 82 ） to （2. 17 ±0. 66） and （ 1.83 ±0. 51 ） （ all P 〈 0. 01 ）. Conclusion Stress can significantly increase the compression of intramural coronary artery and reduce CFR on coronary segments both proximal and distal to the MB. Thus, active exercise might induce myocardial ischemia in patients with myocardial bridging.

关 键 词：多巴酚丁胺 血流动力学 血流速度 壁冠状动脉 心肌桥 

分 类 号：R541.1[医药卫生—心血管疾病]