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目的 对比硝酸酯、小剂量多巴酚丁胺 (Dob)及其合用二维超声心动图 (2DE)试验识别急性心肌梗死 (AMI)存活心肌的准确性和安全性。方法 AMI患者 31例 ,于发病后 7～ 14(10± 3)d行硝酸酯、小剂量Dob及其合用 2DE试验 ,后行冠状动脉血运重建 (CRV)术成功 ,术后 6个月左右(16 7± 18)d复查 2DE。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。将 2DE试验所检的存活心肌与CRV术后其收缩功能改善的实际对比 ,评价识别AMI存活心肌的准确性和安全性。结果 31例AMI患者共有 2 2 1个异常节段。与硝酸酯和Dob 3μg单用时相比 ,两者合用 2DE试验对AMI区存活心肌节段的检出率均显著提高 (5 0 .2 %对 37.6 %和 40 .7% ,P均 <0 .0 5 ) ,识别敏感性和准确性也均显著提高 (77.6 %对 5 6 .8%和 6 1.6 % ,81.0 %对 70 .1%和 72 .4% ,P <0 .0 5～0 0 1) ;而硝酸酯合用Dob 5 μg 2DE试验对存活心肌的检出率、识别敏感性和准确性均已达Dob 10 μg单用时的水平 (5 5 .7%对 5 5 .8% ,87.2 %对 89.5 %和 86 .4%对 87.9% ,P均 >0 .0 5 ) ,而又无Dob 10 μg诱发心肌缺血的副作用。结论 硝酸酯与小剂量 (3、5 μg·kg-1·min-1)Dob合用 2DE试验比两者单用时能提高识别AMI存活心肌的敏感性和准确性 ,还由
Objective To compare the accuracy and safety of nitrates, low-dose dobutamine (Dob) and their combined two-dimensional echocardiography (2DE) in identifying viable myocardium in patients with acute myocardial infarction (AMI). Methods Thirty-one patients with acute myocardial infarction (AMI) received nitrates, low-dose Dob and 2DE at 7-14 (10 ± 3) days after onset, followed by successful coronary revascularization (CRV) (16 7 ± 18) d review 2DE. The 16 segments of semi-quantitative analysis of the left ventricular segments systolic motion and thickening were graded scoring. The accuracy and safety of identifying viable myocardium in AMI were evaluated by comparing the survival of myocardium measured by 2DE with that of CRV after surgery. Results A total of 221 abnormal segments were found in 31 AMI patients. Compared with nitrate and Dob 3μg alone, 2DE test showed that the detection rate of viable myocardial segments in AMI were significantly increased (50.2% vs 37.6% and 40.7%, both P <0). 0 5). The sensitivity and accuracy were also significantly improved (77.6% vs. 56.8% and 61.6%, 81.0% vs. 70.1% and 72.4%, P <0.05-0.00 1). However, the detection rate, identification sensitivity and accuracy of nitrate combined Dob 5 μg 2DE test on viable myocardium reached the level of Dob 10 μg alone (55.7% vs. 55.8%, 87.2 % Vs 89.5% and 86.4% vs 87.9%, P> 0.05), but no side effect of Dob 10 μg induced myocardial ischemia. CONCLUSIONS: Nitric ester and Dob combined with low dose (3,5 μg · kg-1 · min-1) 2DE can improve the sensitivity and accuracy of recognizing AMI viable myocardium when compared with both alone