硝酸酯超声心动图试验识别急性心肌梗塞患者存活心肌的研究  

Nitrate Echocardiography for Identifying Viable Myocardium in Patients with Acute Myocardium Infarction

作　　者：胡奉环[1] 杨跃进[1] 尤士杰[1] 刘剑萍 王燕武[1] 武玉兰 白东峰[1] 王勇[1] 罗军[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院,北京市100037 [2]湖南省郴州市医学专科学校内科教研室

出　　处：《中国超声医学杂志》2000年第6期417-419,共3页Chinese Journal of Ultrasound in Medicine

基　　金：中国医学科学院中国协和医科大学1995年度CMB优秀人才基金资助

摘　　要：目的 :评价硝酸异山梨酯超声心动图 ( 2 DE)识别急性心肌梗塞 ( AMI)患者存活心肌的准确性和安全性。方法 :AMI患者 31例 ,于病后 1～ 2周 (平均 10± 3天 )行硝酸异山梨酯 2 DE试验 ,试验后均成功地接受了冠状动脉血运重建 ( Coronary Revascularization,CRV)术 ,病后 5～ 6个月 (平均 16 7± 18天 )复查 2 DE。用 16节段半定量的方法对左室各节段的收缩运动和增厚情况分级记分 ,用药时或 CRV术后≥ 2个月相邻异常节段有收缩运动改善 (减少≥ 1分 )称为存活心肌 ,将试验时检出的存活心肌节段与 CRV术后相应节段收缩功能改善的实际对比 ,计算硝酸异山梨酯 2 DE试验识别存活心肌的准确性 ,并评价其安全性。结果 :31例 AMI患者的 2 2 1个运动异常节段中 ,硝酸异山梨酯 (平均 2 86 .5± 2 5 .5μg/ min) 2 DE试验检出 83 ( 37.6 % )个存活心肌节段 ,与 CRV术后运动改善相应节段的实际对比 ,识别存活心肌的敏感性、特异性、 PPV、 NPV和准确性分别为 5 6 .8%、 87.5 %、 85 .5 %、6 0 .9%和 70 .1%。所有患者均无明显的副作用。结论 :硝酸异山梨酯 2 DE试验是识别 AMI存活心肌特异和安全的方法 。Objective:To evaluate the accuracy and safety of Isosorbide dinitrate(Isoket,intravenous agent,Schwarz Pharma CoGermany)twodimentional echocardiogrphy(2DE)in identifying viable myocardium for patients with acute myocardium infarction(AMI).Methods:In 31 patients with acute myocardial infarction who were scheduled to undergo coronary revascularization(CRV)Isosorbide dinitrate 2DE tests were conducted within 12 weeks(the mean of 10±3 days)after the infarction CRV was successful in all patients including angioplasty of 29 and bypass surgery of 2,and the followup 2DE were also done about 5～6 months(the mean of 167±18 days)after CRVLeft ventricular regional wall motion and thickening in each segment were graded and scored using a 16segment model and semiquantitative analysis methodThe detected viable myocardium,defined as ≥1 score decreasing in at least two adjacent abnormal segments on the test,were compared with the postCRV actual contractile improvement of corresponding segments to calculate the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of the test for identifying viable myocardium and the safety of the test were evaluated.Result:Among 221 abnormal segments in 31 patients with AMI,83 viable myocardial segments(367%)were detected during Isosorbide dinitrate infusion at a mean dose of 2865±255μg/min,125 segments(566%)showed≥1 score contractile improvement at followup 2DEThe sensitivity,specificity,PPV,NPV and accuracy of Isosorbide dinitrate 2DE test were 568%、875%、855%、609%and 701%,respectivelyDuring Isosorbide dinitrate infusion the only hemodynemic response was a slight but significant increasing in heart rate(707% vs 726%,P<001).No any side dffect occurred in all patients.Conclusion:Isosrbide dinitrate 2DE test was a high specific,less sensitive and safe method for detecting viable myocardium after AMI

关 键 词：存活心肌 超声心动图 硝酸异山梨酯 心肌梗塞 

分 类 号：R542.22[医药卫生—心血管疾病]