多巴酚丁胺负荷二维应变评价心肌存活性的研究  

Evaluation of Viable Myocardium by Two-dimensional Strain Combined with Low Dose Dobutamine Stress Echocardiography

作　　者：卢岷[1] 王志刚[2] 冉海涛[1] 曹小玲[1] 张群霞[1] 孙幼屏[2] 李宜蓁[2] 

机构地区：[1]重庆医科大学附属第二医院超声科,重庆市400010 [2]重庆医科大学超声影像学研究所

出　　处：《中国超声医学杂志》2011年第11期964-966,973,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.81071158)

摘　　要：目的探讨二维应变技术联合负荷超声评价犬急性心肌缺血再灌注模型存活心肌的应用价值。方法 24只健康杂种犬,阻断其左冠状动脉前降支90 min后再灌注120 min。运用二维斑点追踪显像(speckle tracking im-aging,SRI)分别检测静息状态、再灌注状态和小剂量多巴酚丁胺负荷状态下左室前壁、前间壁各节段收缩期峰值纵向应变(peak-systoliclongitudinal strain,SL_(peak))、径向应变(peak-systolic radial strain,SR_(peak))、圆周应变(peak-systolic circumferen-tial strain,SC_(peak))。以用氯化三苯基四氮唑(2,3,5—triphenyltetrazoliumchloride,TTC)和伊文思蓝(Evans blue,EB)染色结果为标准,将前壁、前间隔各节段分为存活节段组和非存活节段组。结果 (1)基础状态下,存活节段组和非存活节段组之间SL_(peak)、SR_(peak)、SC_(peak)无显著性差异(P>0.05);(2)再灌注后,存活组和非存活组SL_(peak)、SR_(peak)、SC_(peak)均降低,但两组比较无显著性差异(P>0.05);(3)与负荷试验前比较,多巴酚丁胺负荷后存活节段组SL_(peak)、SR_(peak)、SC_(peak)显著性增加(P<0.05),非存活节段组各指标无明显变化(P>0.05);存活节段组与非存活节段组比较有显著性差异(P<0.05)。结论小剂量多巴酚丁胺负荷超声联合二维应变可准确评价心肌存活性。Objective To evaluate the myocardial viability by two-dimensional strain combined with low dose dobutamine stress echocardiography. Methods In twenty four anesthetized mongrel dogs, the left anterior descending artery was occluded for 90 min followed by 120 min reperfusion. Two-dimensional strain of anterior wall and anterior septum, include peak systolic longitudinal strain （SLpeak）, circumferential strain （SCpeak） and radial strain （SRpeak）, were measured at baseline, after reperfusion and dobutamine stress. To assess viable or nonviable myocardium, triphenyl tetrazolium chloride （TTC） and Evans blue staining were applied. Results During baseline, statistical significance of SLpeak ,SRpeak and SCpeak does not present between viable and nonviable myocardium group（P〈0.05）. Same as that observed after reperfusion except strain decreased without significance （P〉0.05）. While low dose dobutamine stressing, SLpeak ,SRpcak and SCpeak of viable myocardium group increased significantly compared with that detected after reperfusion（P〈0.05）. Significant variances were presented between viable and nonviable myocardial group during stress. Strain variance of nonviable myoeardium group during dobutamine stress does not observe compared that detec ted after reperfusion （P〉0.05）. Conclusions Combined with dobutamine stress, quantitive analysis by two dimensional strain could be applied to differentiate viable and nonviable myocardium.

关 键 词：存活心肌 二维应变 多巴酚丁胺 负荷超声心动图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]