小剂量多巴酚丁胺-硝酸酯超声心动图对急性心肌梗塞室壁运动异常自发改善的预测价值  

The Predicting Value of Low dose Dobutamine nitrate Echocardiography for Spontaneous Functional Improvement of Dyssynergic Segments in Patients with Acute Myocardial Infarction

作　　者：胡奉环[1] 尤士杰[1] 杨跃进[1] 王燕武[1] 高润霖[1] 李雪芝[1] 陈纪林[1] 姚康宝[1] 徐义枢[1] 陈在嘉[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

出　　处：《中国超声医学杂志》2000年第10期744-747,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 :观察急性心肌梗塞 (AMI)运动异常节段功能的自发性改善 ,评价小剂量多巴酚丁胺 (Dob) -硝酸酯二维超声心动图 (2 DE)试验的预测价值和安全性。方法 :AMI患者 17例 ,于梗塞后 7～ 14(10± 3)天行小剂量 (3和5μg/ kg/ min) Dob-异舒吉 2 DE试验 ,6个月左右〔(16 3± 17)天〕行 2 DE复查。用 16 -节段半定量分析法对左室各节段收缩运动和增厚情况给予分级记分。依据随诊时运动异常节段收缩功能改善情况 ,计算小剂量 Dob-异舒吉 2 DE试验预测 AMI运动异常节段收缩功能自发改善的准确性 ,并评价其安全性。结果 :17例首次 AMI患者 134个异常节段中 ,2 DE试验时检出了 5 6 (4 1.8% )和 5 5 (4 1.0 % )个存活心肌节段 ,随诊时有 5 1个节段 (38.1% )收缩功能有自发改善。因此 ,小剂量 Dob(3、5 μg/ kg/ min)合用异舒吉 2 DE试验预测自发改善的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 82 .4%～ 86 .3%、83.1%～ 86 .7%、82 .4%～ 80 .0 %、82 .5 %～ 91.1%和 82 .8%～ 86 .6 % ;同时发现对运动减低节段预测的敏感性和阳性预测值均高于无运动节段 ,也无诱发心肌缺血的副作用。结论 :AMI异常节段中约 38.1%可发生功能自发性改善 ,小剂量 (3、5 μg/ kg/ min) Dob合用硝酸酯 2Objective:To observe spontaneous functional improvement of dyssynergic segments improvement in patients with acute myocardial infarction(AMI)and evaluate the predicting value of low dose dobutamine(Dob) nitrate echocardiography for the improvement.Methods:In 17 patients with first AMI,regional wall motion abnormality(RWMA)was evaluated at baseline and the combined low dose(3 and 5μg/kg/min)Dob Isoket 2DE test conducted at 7～14(the mean of 10±3)days after the infarction,and at 6 month (the mean of 163±17 days)follow up.Left ventricular regional wall motion and thickening in each segment were graded and scored using a 16 segment model and semiquantitative analysis method.The viable myocardial segments detected were compared with the actual spontaneous functional improvement of corresponding segments to calculate the sensitivity,specificity,positive predicting value(PPV),negtive predicting value(NPV)and accuracy of the test in predicting function spontaneous improvement.Results:Of 134 dyssynergic segments in 17 patients with AMI,56(41 8%) and 55(41 0%)segments on the 2DE test showed reversible dyssynergy,and 51 segments(38 1%)showed spontaneous functional improvement at 6 month fellow up.Therefore,the sensitivity,specificity,PPV,NPV and accuracy of the combined Dob Isoket 2DE tests for predicting functional improvement in patients with AMI were 82 4%～86 3%、83 1%～86 7%、82 4%～80 0%、82 5%～91 1%和82 8%～86 6%,respectively;and the sensitivity and PPV in hypokinetic segments were higher than those in akinetic segments;and there was no ischemia induced during low dose Dob Isoket 2DE test.Conclusion:The spontaneous functional improvement can happen in 38 1% of dyssynergic segments after first AMI,and low dose(3～5μg/kg/min)Dob nitrate 2DE tests can accurately predict the improvement without inducing ischemia.

关 键 词：心肌梗塞 室壁运动异常 自发改善 超声心动图 

分 类 号：R542.22[医药卫生—心血管疾病] R540.45[医药卫生—内科学]