腺苷负荷实时三维超声心动图试验对冠心病的诊断价值  

Value of adenosine stress three-dimensional echocardiography in diagnosis of coronary artery diseases

作　　者：齐新颜[1] 张萍萍[1] 刘姗姗[1] 杜波[1] 

机构地区：[1]山东省泰安市中心医院心内科,青岛大学在职研究生271000

出　　处：《中华临床医师杂志（电子版）》2007年第1期23-26,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评价实时三维超声心动图(RT3-DE)在腺苷负荷试验中对冠心病(CAD)诊断的敏感性、特异性和准确性,并比较其与二维超声心动图(2DE)敏感性、特异性和准确性的差异。方法随机抽取临床拟诊冠心病患者40例,记录静息状态心率、血压和12导联心电图。先行静态二维及三维超声心动图,然后静脉注射腺苷140μg/(kg·min),用药时间6 min,总剂量0.8mg/kg。分别于给药后3min、终止给药时即6min、终止给药后5min即11min重复上述操作,观察ST段变化、监测血压和心率,并同时记录患者症状和不良反应,储存图像。后处理时,通过测量增厚率观察室壁运动变化,以出现室壁运动异常为阳性。所有入选患者于试验后2周内行冠状动脉造影。以冠脉造影结果为金标准,分别计算2-D ASE及3-D ASE的敏感性、特异性和准确性,并比较两者的差异。结果2-D ASE诊断冠心病的敏感性为83%,特异性为73%,准确性为78%,阳性预测值为71%,阴性预测值为84%;3-D ASE诊断冠心病的敏感性为94%,特异性为91%,准确性为93%,阳性预测值为89%,阴性预测值为95%。试验中不良反应发生率为60%,但症状轻微,无严重不良反应。结论与2-D ASE相比,3-D ASE是可行的,不仅弥补了2-D ASE的不足之处,而且对于CAD诊断更具优势。Objective To explore the sensitivity, specificity and accuracy of adenosine stress three- dimensional echocardiography in the diagnosis of coronary artery diseases, and comparing, with two- dimensional echocardiography. Methods In 40 cases of suspected coronary artery diseases, the rest heart rate, blood pressure and electrocardiogram was recorded. After completing the three-dimensional echocardiography and two-dimensional echocardiography examination, then the adenosine 140 μg/（ kg · min） intravenously, which continued for 6 minutes, total dosage 0.8 mg/kg. The echocardiography process repeated in 3 minutes and 6 minutes from the injection, and 5 minutes after injection respectively. The changes of the ST segments, heart rate and blood pressure were monitored. Measuring the thickening rate of ventricular wall, resulting the new abnormal regional wall motion was positive stress test. All the patients were undergone the coronary angiography within 2 weeks. The results of the three-dimensional echocardiography and two-dimensional echocardiography with the coronary angiography was compared. Results There were significant difference in the sensitivity （94% vs. 83% ,P 〈 0.05 ）, specificity （91% vs. 73% ,P 〈0.05）, accuracy （93% vs. 78% ,P 〈0.05）, positive predictive value （89% vs. 71%, P 〈 0.05） and negative predictive value （ 89% vs. 84%, P 〈 0.05 ） between the adenosine stress three- dimensional echocardiography and the two-dimensional echocardiography respectively. Mild adverse effect was 60%. There was no severe adverse effects. Conclusions The adenosine stress three-dimensional echocardiography is feasible in the diagnosis of coronary artery diseases, which has more advantages comparing with the two dimensional echocardiography.

关 键 词：冠状动脉疾病 腺苷 超声心动描记术 三维 

分 类 号：R541.4[医药卫生—心血管疾病]