Zahn R, Lotter R, Nohl H, Schiele R, Bergmeier C, Zander M, Seidl K, Senges J
Herzzentrum Ludwigshafen, Kardiologie, Klinikum der Stadt Ludwigshafen.
Z Kardiol. 1996 Jan;85(1):28-34.
The use of dobutamine stress echocardiography for the evaluation of coronary artery disease is rapidly expanding. Despite its widespread use, the feasibility and safety of dobutamine stress echocardiography has not been sufficiently documented. Between November 1992 and June 1995, we performed 1000 dobutamine stress echocardiographies. There were 744 men and 256 women with a mean age of 59 +/- 11 years. Anti anginal medication was not routinely withdrawn before the test. The mean maximal dobutamine dose was 41,4 +/- 10 mu g/kg center dot min(-1). Atropine was given additionally in 440 patients, with a mean dose of 0.5 mg. In patients receiving beta-blockers additional atropine was more often necessary as compared to those not receiving beta-blockers (278/457 = 61% versus 162/543 = 30 %, p < 0.0001). Reasons for discontinuing dobutamine infusion were achievement of target heart rate (64 % of cases) and maximal dose (12 % of cases). In 791 (79,1 %) patients no side-effects of dobutamine stress echocardiography were noticed. Termination of the study because of adverse side-effects occurred in 6.6 %. A total of 103 (10,3 %) noncardiac side-effects were observed: dizziness or nausea 6.4 %, headache 1.7 %. In one patient a focal cerebral seizure occurred. 156 cardiac side-effects occurred: blood pressure decrease of more than 20 mm Hg in 25 patients, extreme palpitations in 16 patients and pulmonary edema in one case. Most common cardiac side-effects consisted of arrhythmias (11.4 %): 9.1 % ventricular and 2.3 % supraventricular arrhythmias. Most ventricular arrhythmias were less severe (uniform and multiform premature ventricular beats, ventricular bigeminy or couplets in 71 patients). Nonsustained ventricular tachycardia, with a maximum duration of 20 s, occurred in 18 patients. In one patient sustained ventricular tachycardia developed and progressed towards ventricular fibrillation. This patient could be successfully defibrillated. Supraventricular arrhythmias presented as new atrial fibrillation in 10 patients, supraventricular tachycardia in three patients, junctional rhythm with a short decline in heart rate in nine patients and a second-degree AV block in another case. Dobutamine stress echocardiography has proven to be a safe and feasible method in the diagnosis of coronary heart disease. Minor side-effects are common and sometimes unpleasant for the patient, but do not often require termination of the study. Severe side-effects are seldom (< 1 %), but nevertheless, adequate medical and technical (defibrillator) support should be rapidly available.
多巴酚丁胺负荷超声心动图用于评估冠状动脉疾病的应用正在迅速扩展。尽管其使用广泛，但多巴酚丁胺负荷超声心动图的可行性和安全性尚未得到充分记录。在1992年11月至1995年6月期间，我们进行了1000例多巴酚丁胺负荷超声心动图检查。有744名男性和256名女性，平均年龄为59±11岁。试验前未常规停用抗心绞痛药物。多巴酚丁胺的平均最大剂量为41.4±10μg/kg·min⁻¹。440例患者额外给予了阿托品，平均剂量为0.5mg。与未接受β受体阻滞剂的患者相比，接受β受体阻滞剂的患者更常需要额外给予阿托品（278/457 = 61% 对 162/543 = 30%，p < 0.0001）。停止多巴酚丁胺输注的原因是达到目标心率（64%的病例）和最大剂量（12%的病例）。791例（79.1%）患者未观察到多巴酚丁胺负荷超声心动图的副作用。因不良副作用而终止研究的占6.6%。共观察到103例（10.3%）非心脏副作用：头晕或恶心6.4%，头痛1.7%。1例患者发生局灶性癫痫发作。发生了156例心脏副作用：25例患者血压下降超过20mmHg，16例患者极度心悸，1例患者发生肺水肿。最常见的心脏副作用是心律失常（11.4%）：室性心律失常9.1%，室上性心律失常2.3%。大多数室性心律失常不太严重（71例患者出现均匀和多形性室性早搏、室性二联律或三联律）。18例患者发生非持续性室性心动过速，最长持续时间为20秒。1例患者发生持续性室性心动过速并进展为心室颤动。该患者成功除颤。室上性心律失常表现为10例患者新发房颤，3例患者室上性心动过速，9例患者交界性心律伴心率短暂下降，另1例患者二度房室传导阻滞。多巴酚丁胺负荷超声心动图已被证明是诊断冠心病的一种安全可行的方法。轻微副作用很常见，有时会让患者不适，但很少需要终止研究。严重副作用很少见（<1%），但尽管如此，应迅速提供足够的医疗和技术（除颤器）支持。
