在麻醉患者大剂量多巴酚丁胺输注期间，舒张期二尖瓣血流速度的多普勒指数并非心肌缺血的有效指标。
Doppler indices of diastolic transmitral flow velocity are invalid indicators of myocardial ischaemia during high-dose dobutamine infusion in anaesthetized patients.
作者信息
Filipovic M, Seeberger M D, Rohlfs R, Dergeloo O, Studer W, Atar D, Buser P, Skarvan K
机构信息
University of Basel, Department of Anaesthesia, Switzerland.
出版信息
Eur J Anaesthesiol. 2002 Nov;19(11):789-95. doi: 10.1017/s0265021502001278.
BACKGROUND AND OBJECTIVE
Doppler echocardiography of diastolic transmitral flow velocity is more sensitive for the detection of myocardial ischaemia in awake patients than echocardiographic analysis of systolic wall motion. However, its diagnostic value in anaesthetized patients is unknown.
METHODS
Doppler indices of diastolic transmitral flow velocity previously found to be highly sensitive for detecting ischaemia in awake patients were studied in 72 anaesthetized patients with documented coronary artery disease undergoing dobutamine stress echocardiography. These Doppler indices were compared with standard echocardiographic and electrocardiographic criteria for ischaemia.
RESULTS
Sixty-five patients showed evidence of ischaemia by standard echocardiographic and/or electrocardiographic criteria, and seven patients did not. Regardless of evidence of ischaemia by standard criteria, the Doppler indices changed similarly in both groups. Accordingly, only a minority of anaesthetized patients displayed the changes in Doppler indices of diastolic transmitral flow previously suggested to be sensitive for detecting ischaemia.
CONCLUSIONS
The results do not confirm the diagnostic value of Doppler echocardiography of diastolic transmitral flow velocity for detecting ischaemia in anaesthetized patients undergoing dobutamine stress echocardiography during positive-pressure ventilation of the lungs.
背景与目的
对于清醒患者，舒张期二尖瓣血流速度的多普勒超声心动图检查在检测心肌缺血方面比收缩期室壁运动的超声心动图分析更为敏感。然而，其在麻醉患者中的诊断价值尚不清楚。
方法
在72例接受多巴酚丁胺负荷超声心动图检查且有冠状动脉疾病记录的麻醉患者中，研究了先前发现对清醒患者缺血检测高度敏感的舒张期二尖瓣血流速度的多普勒指标。将这些多普勒指标与缺血的标准超声心动图和心电图标准进行比较。
结果
65例患者根据标准超声心动图和/或心电图标准显示有缺血证据，7例患者没有。无论标准标准显示的缺血证据如何，两组的多普勒指标变化相似。因此，只有少数麻醉患者表现出先前认为对检测缺血敏感的舒张期二尖瓣血流多普勒指标变化。
结论
结果未证实舒张期二尖瓣血流速度的多普勒超声心动图在正压通气的肺脏时接受多巴酚丁胺负荷超声心动图检查的麻醉患者中检测缺血的诊断价值。
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