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目的 :观察急性心肌梗塞 (AMI)运动异常节段功能的自发性改善 ,评价小剂量多巴酚丁胺 (Dob) -硝酸酯二维超声心动图 (2 DE)试验的预测价值和安全性。方法 :AMI患者 17例 ,于梗塞后 7～ 14(10± 3)天行小剂量 (3和5μg/ kg/ min) Dob-异舒吉 2 DE试验 ,6个月左右〔(16 3± 17)天〕行 2 DE复查。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。依据随诊时运动异常节段收缩功能改善情况 ,计算小剂量 Dob-异舒吉 2 DE试验预测 AMI运动异常节段收缩功能自发改善的准确性 ,并评价其安全性。结果 :17例首次 AMI患者 134个异常节段中 ,2 DE试验时检出了 5 6 (4 1.8% )和 5 5 (4 1.0 % )个存活心肌节段 ,随诊时有 5 1个节段 (38.1% )收缩功能有自发改善。因此 ,小剂量 Dob(3、5 μg/ kg/ min)合用异舒吉 2 DE试验预测自发改善的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 82 .4%～ 86 .3%、83.1%～ 86 .7%、82 .4%～ 80 .0 %、82 .5 %～ 91.1%和 82 .8%～ 86 .6 % ;同时发现对运动减低节段预测的敏感性和阳性预测值均高于无运动节段 ,也无诱发心肌缺血的副作用。结论 :AMI异常节段中约 38.1%可发生功能自发性改善 ,小剂量 (3、5 μg/ kg/ min) Dob合用硝酸酯 2 DE试验对此有较
OBJECTIVE: To observe the spontaneous improvement of functional abnormalities in acute myocardial infarction (AMI) and to evaluate the predictive value and safety of low-dose dobutamine (Dob) -nitrate two-dimensional echocardiography (2 DE). Methods: Seventeen patients with acute myocardial infarction (AMI) were treated with Dob-Isoctuet DE 2 DE at 7-14 (10 ± 3) days after infarction. After 6 months (16 3 ± 17 ) God] line 2 DE review. The 16 - segmental semi - quantitative analysis of the left ventricular segments systolic motion and thickening were graded scoring. According to the improvement of systolic dysfunction segment at follow-up, the Dob-Isorghizir 2 DE test was used to predict the accuracy of spontaneous improvement of systolic dysfunction in AMI and to evaluate its safety. RESULTS: Of the 134 abnormal segments in 17 patients with first AMI, 56 (4 1.8%) and 55 (4 1.0%) viable myocardium segments were detected at 2 DE test and 51 were followed up Segment (38.1%) had spontaneous systolic function improvement. Thus, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the low-dose Dob (3,5 μg / kg / min) combined with Isotocid 2 DE test to predict spontaneous improvement were 82.4% to 86 .3%, 83.1% -86.7%, 82.4% -80.0%, 82.5% -91.1%, and 82.8% -86.6%, respectively. Meanwhile, they were also found to be sensitive to segment loss prediction The predictive values of both sexes and masculine gender are higher than those of non-locomotor segments and have no side effects of inducing myocardial ischemia. CONCLUSIONS: About 38.1% of AMI abnormalities may have spontaneous improvement in function, and low dose (3,5 μg / kg / min)