【摘要】 目的 评价小剂量多巴酚丁胺超声心动图试验(LDDE)在急性心肌梗塞早期对心肌梗塞后局部左室功能改善的预测价值。方法 对71例急性心肌梗塞患者于发病后2周内行LDDE,观察静态、静注多巴酚丁胺(5、10μg*kg^-1 *min^-1 )及心梗后3个月局部室壁运动变化。结果 LDDE发现静态时运动减弱节段的心肌存活比无运动节段更常见(分别为50%和15%,P<0.0001,优势比为5.27,95%可信区间为3.02～9.21)。静态时运动减弱节段在随访时局部功能改善比无运动节段更常见(分别为50%和23%,P<0.0001,优势比为3.35,95%可信区间为1.98～5.67)。以随访时节段局部功能改善作为心肌存活的参考标准,LDDE预测节段局部功能改善总的敏感性、特异性分别为73%、92%。根据LDDE时室壁运动反应分为心肌存活组(A组,31例)及无存活组(B组,40例)。A组随访时室壁运动指数较静态时下降(1.46±0.31降至1.21±0.30,P=0.0016), B组则无改变。随访时与静态时室壁运动指数差值绝对值A组明显高于B组(分别为0.250±0.012与0.060±0.104,P<0.0001)。结论 LDDE能鉴别急性心肌梗塞后的存活心肌，并能预测左室局部功能的改善，具有较高的特异性，是一种简便和安全的鉴别心肌存活技术。

    Clinical Study of Low-Dose dobutamine echocardiography Fang Ligang, Zhu Wenling, Guo Lilin, et al. PUMC Hospital, Beijing100730

     【Abstract 】 Objective This study wasperformed to detect viable myocardium using low-dose dobutamine echocardiography (LDDE)and evaluate the role of this method for predicting the improvement of regional leftventricular (LV) function in 71 patients with a first acute myocardial infarction (Q wave)within 2 weeks after onset of acute MI. Methods Regionalwall motion was evaluated with 2-dimensional echocardiography at rest, during dobutamineinfusion (5,10 μg*kg^-1 *min^-1 )and that at 3-month follow-up. Results Viability ofmyocardium detected by LDDE was more frequent in hypokinetic segments than that inakinetic segments (50% vs 15%, P<0.0001,odds ratio [OR ] 5.27, 95% confidenceinterval [CI ] 3.02to 9.21). Spontaneous recovery of mycar-dium at follow-up was more frequent in hypokineticsegments than that in akinetic segments (50% vs 23%, P<0.0001, OR 3.35, CI 1.98 to5.67). Sensitivity and specificity of detecting viable segments by LDDE were 73% and 93%,respectively. Myocardial viability in the infarct zone by LDDE was documented in 31patients(group A) and absent in 40 patients(group B).At follow-up, recovery of regionalcontractile function was observed in group A (RWMI decreased from 1.46±0.31 to 1.21±0.30;P=0.0016),but not in group B patients.Conclusion Low-dosedobutamine echocardiography can be safely performed to detect viable myocardium earlyafter acute MI. It may predict improvement of regional left ventricular function with ahigh specificity.

     【Key words 】 echocardiography dobutamine myocardial infarction

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