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目的 观察扩张型心肌病 (DCM)及缺血性心肌病 (ICM)患者在多巴酚丁胺负荷超声心动图 (DSE)中的室壁运动规律。方法 18例心脏扩大、心力衰竭患者微泵滴注多巴酚丁胺、按 5 μg/ (kg·min)、10 μg/ (kg·min)、2 0 μg/ (kg·min)、30 μg/ (kg·min)、4 0 μg/ (kg·min)的顺序递增 ,每个剂量持续 3分钟。全程连续观察超声心动图并记录。全部患者同期行冠脉造影检查。结果 ①随药物剂量逐级递增 ,DCM患者左室舒张末径缓慢缩小、左室射血分数持续增加 ;ICM患者左室舒张末径无明显变化 ,左室射血分数仅在低剂量时增加。②高剂量时节段室壁运动异常在DCM患者中占14 % ,在ICM患者中占 80 %。二者比较有显著差异 (P <0 0 1)。③根据高剂量时节段室壁运动异常预测ICM ,其敏感性 80 % ,特异性 87% ,阳性预测值 88% ,阴性预测值 77%。结论 DSE试验有助于临床对DCM及ICM的鉴别诊断。
Objective To observe the wall motion of patients with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) in dobutamine stress echocardiography (DSE). Methods Eighteen patients with cardiac enlargement and heart failure were treated with micro-pump infusion of dobutamine at a dose of 5 μg / (kg · min), 10 μg / (kg · min), 20 μg / (kg · min), 30 μg / (kg · min), 40 μg / (kg · min), with each dose lasting 3 minutes. Continuous observation of echocardiography and record. All patients underwent coronary angiography at the same period. Results ① With the gradual increase of drug dose, left ventricular end-diastolic diameter of patients with DCM slowly decreased and left ventricular ejection fraction increased continuously. Left ventricular end-diastolic diameter of patients with ICM did not change significantly, left ventricular ejection fraction increased only at low dose. ② High-dose segmental wall motion abnormalities in DCM patients accounted for 14%, 80% of ICM patients. There was a significant difference between the two (P <0.01). (3) According to the prediction of ICM by segment wall motion abnormality at high dose, the sensitivity and specificity were 80%, 87%, 88% and 77% respectively. Conclusions The DSE test is helpful for the differential diagnosis of DCM and ICM in clinic.