Cladellas Capdevila M, Bruguera Cortada J, Hernández Herrero J, Villena Segura J, Serrat Serradell R
Servicio de Cardiología, Hospital Universitario del Mar, Barcelona, IMAS.
Rev Esp Cardiol. 1996 Jan;49(1):22-8.
To study the side effects of dobutamine echocardiography and to define the protocol with less side effects.
Since June 1992 to November 1994 dobutamine echocardiography was performed on two different groups of patients. In the first, the test was preoperatively done to evaluate the surgical risk. The remaining were patients with angina. Dobutamine was started at a dose of 5 micrograms/kg/min and increased up to a total dose of 40 micrograms/kg/min. Since March 1993 atropine was added if the heart rate was under 90 beats/min.
One hundred and forty one patients were included (76 for a preoperatory appraisal and 65 with angina). Echocardiography test was not performed on 3 patients (2 with pulmonary disease and 1 with a therapeutic neumothorax). Among the remaining 138 patients, side effects appeared in 53 patients (38%) and test had to be prematurely interrupted in 11 (8%) of them. Side effects presented during the test in 9 (7%) although it could be finished and at the end of the test in 33 (24%). The most frequent side effects were arrhythmias that appeared in 28 patients (20%) and were considered significant in 17: 7 with supraventricular tachycardia, 7 with more than 6 ventricular premature systoles per minute, 2 with ventricular tachycardia and 1 with multifocal supraventricular premature systoles. These arrhythmias were observed when the dose of dobutamine was 20 micrograms/kg/min or more (p < 0.05). Hypotension developed in 11 patients (8%) and noncardiac effects in 13 (9%). The dobutamine test was interrupted for arrhythmias in 4% of cases, noncardiac side effects in 2% and poor image quality in 3%. A steady increment of heart rate 5 minutes after infusion of atropine was detected in 12 patients (maximal: 93 +/- 23 beats per minute; after five minutes: 94 +/- 19) and side effects were encountered in only one of these patients (hypotension).
Intravenous administration of dobutamine during echocardiography can be finished in the majority of patients with good tolerance in spite of its side effects. Arrhythmias with dose over 20 micrograms/kg/min, poor image quality and chronotropic insufficiency are the most frequently encountered limitations.
研究多巴酚丁胺超声心动图的副作用，并确定副作用较少的方案。
1992年6月至1994年11月，对两组不同患者进行了多巴酚丁胺超声心动图检查。第一组在术前进行该检查以评估手术风险。其余为心绞痛患者。多巴酚丁胺起始剂量为5微克/千克/分钟，并逐渐增加至总剂量40微克/千克/分钟。自1993年3月起，如果心率低于90次/分钟，则加用阿托品。
共纳入141例患者（76例用于术前评估，65例为心绞痛患者）。3例患者未进行超声心动图检查（2例患有肺部疾病，1例患有治疗性气胸）。在其余138例患者中，53例（38%）出现副作用，其中11例（8%）检查不得不提前中断。9例（7%）在检查过程中出现副作用，但检查可以完成，33例（24%）在检查结束时出现副作用。最常见的副作用是心律失常，28例（20%）出现心律失常，其中17例被认为较为严重：7例为室上性心动过速，7例每分钟室性早搏超过6次，2例为室性心动过速，1例为多源性室上性早搏。当多巴酚丁胺剂量达到20微克/千克/分钟或更高时，观察到这些心律失常（p < 0.·05）。11例患者（8%）出现低血压，13例患者（9%）出现非心脏方面的副作用。因心律失常中断多巴酚丁胺检查的占4%，因非心脏副作用中断的占2%，因图像质量差中断的占3%。12例患者在输注阿托品后五分钟心率稳步增加（最大值：93±23次/分钟；五分钟后：94±19次/分钟），其中仅1例患者出现副作用（低血压）。
尽管多巴酚丁胺超声心动图检查有副作用，但大多数患者静脉注射多巴酚丁胺时耐受性良好，检查能够完成。剂量超过20微克/千克/分钟时出现的心律失常、图像质量差和变时功能不全是最常见的限制因素。
