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目的 评价急性心肌梗死后小剂量多巴酚丁胺超声心动图试验 (LDDSE) ,对梗死区存活心肌的识别价值和早期静脉溶栓的疗效。方法 对 31例Q波急性心梗患者 (其中 1 8例尿激酶溶栓治疗 )于发病后 4周行LDDSE。多巴酚丁胺按 5 μg/ (kg·min) ,持续 5分钟静脉给药 ,观察给药前后梗死区心肌室壁运动 ,计算室壁运动得分指数 (WMSI)。 1 4例 4月后随访观察室壁运动恢复情况。结果 31例急性心梗患者 496个节段 ,基础状态下发现室壁运动异常 87个节段。LDDSE发现 49个节段 (5 6 .3% )室壁运动有不同程度的改善。LDDSE后WMSI低于基础状态 (1 .1 2± 0 .1 6和 1 .2 6± 0 .1 5 ,P <0 .0 1 )。溶栓组LDDSE后WMSI明显低于基础状态 (1 .0 8± 0 .1 2和 1 .2 7± 0 .1 6 ,P <0 .0 1 ) ,溶栓组LDDSE后室壁运动明显增强者明显高于非溶栓组 (6 4.8%和 36 .4% ,P <0 .0 1 )。 4月后随访 1 4例 38个节段异常中室壁运动恢复 1 9节段 (5 0 % )。结论 提示 87个节段运动异常的心肌中有 49个节段 (5 6 .3% )具有存活性。基础状态时减弱节段的存活心肌比无运动节段更常见 (73.6 %和 35 .5 % ,P <0 .0 1 )。早期静脉溶栓治疗可明显提高梗死区的存活心肌。LDDSE对梗死区存活心肌的识别敏感、安全、可靠、易重复 ,具有重要的临床?
Objective To evaluate the value of low dose dobutamine echocardiography (LDDSE) after acute myocardial infarction (MI) in identifying myocardial viable myocardium in infarcted area and early intravenous thrombolysis. Methods 31 cases of Q wave acute myocardial infarction (including 18 cases of urokinase thrombolytic therapy) LDDSE 4 weeks after onset. Dobutamine was administered intravenously at a dose of 5 μg / (kg · min) for 5 minutes. The ventricular wall motion in the infarcted area before and after administration was observed and the wall motion score index (WMSI) was calculated. 14 cases were followed up after 4 months to observe the recovery of wall motion. Results A total of 496 segments of 31 patients with acute myocardial infarction were found. There were 87 segments of abnormal wall motion in basal state. LDDSE found that 49 segments (56.3%) had varying degrees of improvement in wall motion. WMSI after LDDSE was lower than basal (1 .12 ± 0 .16 and1.26 ± 0 .15, P <.01). WMSI in the thrombolysis group was significantly lower than that in the basal state (1.08 ± 0.12 and 1.27 ± 0.16, P <0.01), and the wall motion in the thrombolytic group was significantly increased after LDDSE Were significantly higher than those in the non-thrombolytic group (6 4.8% vs 36.4%, P <0.01). Four months later, 14 cases were retrospectively analyzed, and the wall motion was recovered in 19 segments (50%). The results suggest that there are 49 segments (56.3%) in the 87 segments with abnormal myocardial activity. The viable myocardium of the weakened segments was more common at baseline than the non-motor segments (73.6% vs 35.5%, P <0.01). Early intravenous thrombolytic therapy can significantly improve the survival of myocardial infarction area. LDDSE myocardial infarction in the identification of viable myocarditis sensitive, safe, reliable, easy to repeat, with important clinical?