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目的探讨多普勒组织成像(DTI)结合小剂量多巴酚丁胺在心肌活性诊断临床应用中的可行性,为有效防治心血管疾病的发生、发展提供参考依据。方法随机选取2012年3月至2014年9月广东省惠州市第一人民医院治疗的疑似冠心病患者47例,均进行心脏彩超、心电图等检查。记录糖尿病史、高血压史、心率等资料,采用DTI结合小剂量多巴酚丁胺对患者心肌活性进行检测,并与硝酸甘油介入心肌显像进行对照分析。结果冠状动脉造影检查结果显示11例为正常患者,36例被确诊为冠心病。超声心动图静息DTI检测36例冠心病患者室壁节段480个,未见室壁矛盾运动,其中61个运动消失节段,99个运动减弱节段,152个运动异常节段。除个别节段外,与正常组相应节段相比,冠心病组异常节段速度值中S峰、E峰、A峰值速度均较低(P均<0.05)。采用小剂量多巴酚丁胺结合超声心动图静息和负荷DTI检测36例冠心病患者室壁节段480个,检测出运动异常节段159个中有68个节段无变化,为坏死心肌节段组;91个节段运动改善,为存活心肌节段组。各组峰值速度静息与负荷状态比较均有统计学差异(P<0.01);两组间峰值速度静息时比较差异不明显(P>0.05),负荷时比较有统计学差异(P<0.05)。以36例冠心病患者硝酸甘油介入心肌显像对存活心肌诊断的结果为准,小剂量多巴酚丁胺结合DTI诊断存活心肌的特异度为74.3%,敏感度为82.0%,阳性预测率为80.2%,阴性预测率为76.5%,诊断准确率为78.6%。结论 DTI结合小剂量多巴酚丁胺能够有效评价心肌活性,其结果与硝酸甘油介入心肌显像较一致。
Objective To investigate the feasibility of Doppler tissue imaging (DTI) combined with low-dose dobutamine in the clinical application of myocardial activity diagnosis, and to provide a reference for effective prevention and treatment of cardiovascular disease. Methods Forty-seven patients with suspected coronary heart disease were selected randomly from March 2012 to September 2014 in Huizhou First People’s Hospital of Guangdong Province. All patients underwent echocardiography and electrocardiogram examination. The history of diabetes mellitus, history of hypertension and heart rate were recorded. Myocardial activity was detected by DTI combined with low-dose dobutamine and compared with myocardial infarction with nitroglycerin. Results Coronary angiography showed that 11 cases were normal and 36 cases were diagnosed as coronary heart disease. Echocardiography resting DTI detected 36 cases of coronary heart disease in patients with wall segment 480, no contractile motion of the wall, of which 61 disappeared segments, 99 decreased motor segments, 152 abnormal motor segments. Except for individual segments, the peak abnormalities in coronary artery disease group were lower than those in normal group (P <0.05). A small dose of dobutamine combined with echocardiography resting and load DTI detection of 36 cases of coronary heart disease in patients with wall segment 480, detected in 159 segments of motion abnormalities in 68 segments without change, as necrotic myocardium Segmental group; 91 segments of exercise improved, as a survival myocardial segment group. There was a significant difference between peak resting speed and load status in each group (P <0.01). There was no significant difference in resting peak speed between the two groups (P> 0.05) ). The diagnosis of viable myocardium by nitroglycerin interventional cardiography was performed in 36 patients with coronary heart disease. The specificity of low-dose dobutamine combined with DTI in diagnosis of viable myocardium was 74.3%, the sensitivity was 82.0%. The positive predictive value was 80.2%, negative predictive rate was 76.5%, diagnostic accuracy was 78.6%. Conclusion DTI combined with low-dose dobutamine can effectively evaluate myocardial activity. The results are in good agreement with the myocardial imaging of nitroglycerin.