多普勒组织成像联合多巴酚丁胺药物负荷试验检测存活心肌的实验研究  

Evaluation of viable myocardium by low-dose dobutamine echocardiography combined with Doppler tissue imaging

作　　者：蒋益波[1] 冯毅[1] 丁建东[1] 王宇[1] 

机构地区：[1]东南大学中大医院心血管内科

出　　处：《第三军医大学学报》2007年第2期134-137,共4页Journal of Third Military Medical University

摘　　要：目的运用多普勒组织成像(Dopplertissueimaging,DTI)结合小剂量多巴酚丁胺负荷试验(low-dosedobu-taminestressechocardiography,LDDSE)的方法检测存活心肌,并将结果与存活心肌的组织病理切片染色结果进行一致性比较,以评价该方法临床应用的可行性。方法选取12只健康小型猪作为实验的研究对象。行冠状动脉造影后球囊堵塞左回旋支分支制作急性心肌梗死模型。制作心肌梗死模型前后各阶段均进行超声心动图检查,使用DTI速度模式,采用两级多巴酚丁胺负荷试验。应用16节段半定量分析室壁运动,选取静息状态下室壁运动异常的心肌节段进行存活性的评价。堵塞90min后撤除球囊,10%KCl静注处死小型猪,TTC染色后进行结果对比。结果①12只猪用超声心动图静息DTI检测192个室壁节段,共检出26个运动异常节段。②行DTI结合LDDSE检测,上述26个运动异常节段中有16个节段运动改善,提示为存活心肌节段(A组)。余10个节段无变化,为坏死心肌(B组)。③DTI结合LDDSE试验诊断存活心肌与组织切片TTC染色结果相比较,其敏感性为92.9%,特异性为75%。结论DTI结合小剂量多巴酚丁胺负荷试验是评价心肌存活性的一项超声新技术,因此有较好的临床应用前景。Objective To evaluate the myocardial viability by combined low-dose dobutamine echocardiography （LDDSE） with Doppler tissue imaging （ DTI）, and compare the efficacy of combined LDDSE with DTI to that of 2, 3, 5-triphenyhetrazolium-chloride （TFC） staining in evaluating viable myocardium. Methods Twelve healthy pigs were examined by electrocardiography before operation. After anesthesia, balloon angioplasty was performed in the branch of the left circumflex artery （LCX）. The balloon was inflated and occluded LCX for 90 min. Electrocardiography, blood pressure and other parameters were monitored. Every pig underwent LDDSE after acute myocardial infarction. 16-segment model and semiquantitative analysis were adopted. Finally all pigs were killed by intravenous injection of 10% KCl, and hearts were stained with TFC and the histochemical changes of myocardial cells were assessed by microscopy. The results by the two methods were compared. Results In 26 of 192 segments that were hypokinetic or akinetic of wall motion with DTI at rest, 16 segments showed improvement of wall motion during LDDSE combined with DTI, documented as viable myocardium （group A）, and 10 segments showed no improvement of wall motion, documented as non-viable myocardium （group B）. Taking TFC staining results as gold standard, the sensitivity and specificity of LDDSE combined with DTI for viable myocardium were 92.9% and 75% respectively. Conclusion DTI combined with LDDSE in identifying viable myocardium is a relatively reliable and ideal method.

关 键 词：多普勒组织成像 超声心动图 多巴酚丁胺 存活心肌 TTC染色 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学] R445.1[医药卫生—基础医学]