硝酸甘油-多巴酚丁胺负荷超声心动图评价心肌梗死部位存活心肌的研究

目的　探讨硝酸甘油 多巴酚丁胺负荷超声心动图识别心肌梗死部位存活心肌的可靠性和安全性。方法　对 2 9例接受冠状动脉血运重建术的陈旧性心肌梗死患者 ,术前行多巴酚丁胺及其合用硝酸甘油超声心动图了解术前室壁运动情况 ,术后 3个月复查室壁运动改善情况 ,以术后相应节段运动改善为标准 ,分析比较术前多巴酚丁胺及其合用硝酸甘油超声心动图判定存活心肌的准确性并评价其安全性。结果　多巴酚丁胺合用硝酸甘油超声心动图判定存活心肌的敏感性、特异性和准确性分别为 90 .9%、95 .6%和 96.2 % ,其敏感性与单用多巴酚丁胺比较虽无统计学差异 (P >0 .0 5 ) ,但已表现出增高趋势 ,而特异性和准确性则不受影响。术前室壁节段运动指数分析提示多巴酚丁胺 10 μg·kg-1·min-1与多巴酚丁胺 5 μg·kg-1·min-1间差异无显著性 (P >0 .0 5 ) ,而多巴酚丁胺 10 μg·kg-1·min-1合用硝酸甘油较多巴酚丁胺 5 μg·kg-1·min-1级明显降低 (P <0 .0 5 )。且多巴酚丁胺合用硝酸甘油无诱发心肌缺血副作用。结论　硝酸甘油 多巴酚丁胺负荷超声心动图识别心肌梗死部位存活心肌比单用多巴酚丁胺更敏感而且更安全

Study of dobutamine combined with nitroglycerin echocardiography in identifying viable myocardium of patients with myocardial infarction

Objective To evaluate the accuracy and safety of dobutamine combined with nitroglycerin echocardiography in identifying viable myocardium of patients with myocardial infarction (MI). Methods Dobutamine and dobutamine combined with nitroglycerin echocardiography were performed in 29 patients with MI to detect the regional wall motion before coronary revascularization. The regional wall motion was detected again about 3 months after operation. According to the actual contractile improvement of regional wall motion of postoperation,the sensitivity, specificity and accuracy of the tests for identifying viable myocardium were calculated.Results The sensitivity, specificity and accuracy of the tests for identiifying viable myocardium were 90.9%, 95.6%, 96.2%, respectively. The sensitivity of dobutamine combined with nitroglycerin echocardiography increased compared with that of dobutamine echocardiography, although no statistical significance was found, while no effects were found in the specificity and accuracy of the tests. A significant decrease of WMSI was found in 10?μg·kg -1·min -1 dobutarmine combined with nitroglycerin echocardiography compared with 5?μg·kg -1·min -1 dobutamine (P<0.05), but there was no significant decrease of WMSI in 10?μg·kg -1·min -1 dobutamine alone compared with 5?μg·kg -1·min -1 dobutamine (P>0.05). No occurrence of ischemia was found in 10?μg·kg -1·min -1 dobutamine combined with nitroglycerin echocardiography as induced in 10?μg·kg -1·min -1 dobutamine alone. Conclusion Dobutamine combined with nitroglycerin echocardiography in identifying the viable myocardium of patients with MI have more sensitivity and safety compared with dobutamine alone.