论文部分内容阅读
目的 :探讨适合中国人的乙酰胆碱试验剂量方案和阳性诊断标准。方法 :选择临床具有静息性胸痛、胸闷病史 ,但冠状动脉(冠脉 )造影无显著狭窄的患者进行乙酰胆碱试验 ,采用乙酰胆碱 1 0、3 0、60和 1 0 0 μg(右冠脉为 80 μg)的阶梯剂量方案 ,以注射乙酰胆碱后出现与平时类似的胸痛或胸闷发作 ,伴冠脉痉挛使狭窄程度达到 90 %和 99%以上的两种阳性诊断标准进行比较。结果 :若以血管狭窄 90 %为标准 ,则在 60 μg时阳性率达高峰 ,敏感性为 92 % ;若以血管狭窄 99%为标准 ,敏感性仅 3 3 % ,1 0 0 μg时阳性患者较 60 μg时略有增加 ,但差异无统计学意义 (P >0 .0 5 ) ;两种标准的特异性均为 1 0 0 %。严重心动过缓或心脏停搏的发生率随剂量增大而增加。结论 :小剂量方案 (最大 60 μg)结合 90 %狭窄率标准更适合中国人的诊断要求
Objective: To investigate the dosage of acetylcholine test suitable for Chinese and the positive diagnostic criteria. Methods: Acetylcholine was tested in patients with clinically silent chest pain and chest tightness, but no significant stenosis of coronary artery (coronary) angiography. The patients were treated with acetylcholine 1 0, 30, 60, and 100 μg (right coronary artery 80 μg). Compared with the usual chest pain or chest tightness after the injection of acetylcholine, two positive diagnostic criteria of coronary spasm with stenosis of 90% and 99% were compared. Results: When the blood vessel stenosis was 90%, the positive rate peaked at 60 μg with a sensitivity of 92%. If the vascular stenosis was 99%, the sensitivity was only 33%, and the positive rate was 100% Slightly higher than 60 μg, but the difference was not statistically significant (P> 0.05); the specificity of the two standards were 100%. The incidence of severe bradycardia or cardiac arrest increased with dose. CONCLUSIONS: The low-dose regimen (up to 60 μg) combined with the 90% stenosis standard is more suitable for Chinese diagnostic requirements