【摘要】 目的　利用小剂量多巴酚丁胺超声心动图 (LDDE)显示心肌梗死部位存活心肌的存在及介入治疗术后整体心脏收缩功能的变化 ,评价介入治疗对存活心肌的作用。方法　选择前降支(LAD)单支闭塞病变拟行介入治疗患者 2 5例 ,均在术前做LDDE ,然后行经皮冠状动脉腔内成形术(PTCA)和支架术 ,术后 2～ 4个月复查二维超声心动图 (2DE) ,LDDE及二维超声心动图 (2DE)均采用16阶段半定量分析法 ,将LDDE显示≥ 2个相邻室壁运动不良节段 (RWMA)收缩功能改善者定为多巴酚丁胺阳性 ,并与介入治疗术后室壁运动改善相对比。术后RWMA改善定为存活心肌 ,并进行心肌收缩功能改善的评价。结果　多巴酚丁胺试验阳性 (持续改善和双向反应 )对存活心肌具有较高的预测价值 ,即在LDDE阳性的 118个室壁运动异常节段中有 10 3个节段介入治疗术后恢复 ,而LDDE阴性的 5 0个室壁运动异常节段仅有 11个节段恢复。此外 ,整体心功能的改善也与室壁运动异常的改善相一致 ,即术后射血分数 (EF)、心排血量 (CO)、心脏指数 (CI)等反映整体心脏功能的指标也有明显改善。结论　LDDE可以发现心肌梗塞部位存活心肌的存在 ,并可预测介入治疗后存活心肌的恢复和心脏整体收缩功能的改善更多还原

【Abstract】 Objective To detect the viable myocardium in infarcted areas and to evaluate the changes in cardiac contractivity after coronary intervention using low dose dobutamine echocardiography (LDDE) Methods 25 patients with only left descending artery occlusion were enrolled and given LDDE before percutaneous transluminal coronary angioplasty (PTCA) and stent and had 2～4 months follow up with echocardiography (2DE). Semi quantitative analysis was applied in LDDE and 2DE: 16 wall motion areas were measured and LDDE results were defined as positive when ≥2 contiguous regional wall motion abnormality (RWMA) were improved during dobutamine infusion The same criterion was used for RWMA improvement after PTCA and stent Results The positive LDDE wall motion areas indicated the high possibility of viable myocardium existence and should have better outcome after revascularization 118 LDDE positive RWMA were showed 103 wall motion recovery after PTCA and stent, furthermore, the indexes of global systolic function, ejection fraction (EF), cardiac output (CO), cardiac index (CI) were parallel to the wall motion improvement which ensured better global systolic function Conclusion LDDE is a valuable test to detect the viable myocardium in myocardial infarction areas and predicts the improvement of wall motion abnormality and global systolic function in myocardial infarction subjects更多还原