冠状动脉内多普勒技术评价多巴酚丁胺负荷试验对急性冬眠心肌相关冠状动脉血流动力学的影响  

The experimental study of intracoronary Doppler in assessing coronary hemodynamic indexes of acute hibernating myocardium during dobutamine stress test

作　　者：李东野[1] 潘德锋[1] 夏勇[1] 徐晤[1] 史春志[1] 钱文浩[1] 沈学东[2] 葛均波[2] 

机构地区：[1]徐州医学院心血管病研究所心内科,221002 [2]复旦大学医学院附属中山医院

出　　处：《中华心血管病杂志》2002年第12期751-755,共5页Chinese Journal of Cardiology

基　　金：江苏省卫生厅重点科研项目(H9809)

摘　　要：目的　观察急性冬眠心肌相关冠状动脉 (冠脉 )血流动力学指标在多巴酚丁胺负荷期间的改变情况及其与急性冬眠心肌的内在联系 ,探讨多巴酚丁胺超声负荷实验 (dobutaminestressechocardiography ,DSE)检查急性冬眠心肌相关冠脉血流动力学的机制。方法　对 1 3只小型中国家猪采用闭胸法建立急性冬眠心肌模型 ,以双相反应作为DSE法检出急性冬眠心肌的阳性标准。采用冠脉内多普勒技术观察DSE期间急性冬眠心肌相关冠脉平均峰值流速 (APV)、舒张收缩流速比值的变化情况 ,并记录DSE期间心率、血压、心率血压二重乘积的变化情况。结果　 (1 ) 1 0只 (77% )家猪成功制备成急性冬眠心肌模型。 (2 )DSE期间急性冬眠心肌相关冠脉APV、舒张收缩流速比值、收缩压、舒张压、心率及心率血压二重乘积均呈上升趋势 ,但使APV出现显著增加的多巴酚丁胺剂量水平(5μg·kg- 1 ·min- 1 )明显低于其他指标出现显著增加的多巴酚丁胺剂量水平 (2 0 μg·kg- 1 ·min- 1 )。 (3)DSE峰值及基础状态APV的变化量与DSE检出的急性冬眠心肌的节段数呈中等程度的正相关 (r =0 66 ,P <0 0 5)。结论　 (1 )DSE期间急性冬眠心肌模型相关冠脉的APV呈上升趋势 ,以舒张期血流增加为主 ,其增加量可能是检测急性冬眠心肌的一个指标。 (2 )Objective To observe the changes of coronary hemodynamic indexes of acute hibernating myocardium (AHM) model during dobutamine stress echocardiography (DSE), determine the relationship between these indexes and AHM, and investigate the mechanism of DSE in assessing AHM Methods Thirteen little domestic Chinese swine were selected to establish the AHM model by interventional method, then they underwent DSE, the segments which appeared biaphasic response were considered AHM Intracoronary Doppler guidewire was used to measure average peak velocity (APV), diastolic systolic velocity ratio(DSVR) of the distal to the stenosis in each stage of DSE Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and RPP were recorded at the same time Results (1) Ten animals (77%) were successfully estabished to be the model of AHM (2) APV, DSVR, SBP, DBP, HR and RPP all increased during DSE, but APV increased more at lower dose stage than other indexes ΔAPV (difference between basic stage and peak dose stage of DSE) correlated to the amounts of AHM segments positively( r =0 66, P <0 05) Conclusions (1)APV increased prominently in diastolic period during DSE and there may be a relationship between ΔAPV and the amount of AHM segments (2) The possible mechanism of DSE in detecting AHM is the unbalance between blood supply and oxygen consumption relatively in regional myocardium (3)The mechanism of APV increased during DSE was different in lower dosage stage from higher dosage stage

关 键 词：急性冬眠心肌 冠状动脉 血流动力学 心肌顿抑 多巴酚丁胺超声负荷试验 多普勒超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学]