Lewandowski T J, Armstrong W F, Bach D S
Department of Internal Medicine, University of Michigan.
J Am Soc Echocardiogr. 1998 Mar;11(3):236-42. doi: 10.1016/s0894-7317(98)70085-9.
In a randomized, controlled clinical trial, we evaluated the ability of an algorithm to identify, before peak stress, patients who will ultimately require atropine during dobutamine stress echocardiography. The effects of early atropine administration on test duration, atropine dose, dobutamine dose, and heart rate response also were studied. Compared with conventional atropine administration at peak dobutamine infusion, early atropine administration reduced test duration 8% (1.1 minutes, p = 0.02) and total dobutamine use 11% (0.41 mg/kg, p = 0.02) but required 90% more atropine (0.36 mg, p < 0.001). Conventional atropine administration resulted in a late, rapid rise in both heart rate and rate-pressure product. However, the heart rate and rate-pressure product curves for patients receiving early atropine paralleled those seen in patients not requiring atropine during dobutamine stress echocardiography. In conclusion, early atropine administration provides a more balanced stress and reduces test duration, thus decreasing total exposure to dobutamine and potentially increasing test efficiency.
在一项随机对照临床试验中，我们评估了一种算法在多巴酚丁胺负荷超声心动图检查中，于应激峰值出现前识别最终需要使用阿托品的患者的能力。我们还研究了早期给予阿托品对检查持续时间、阿托品剂量、多巴酚丁胺剂量及心率反应的影响。与在多巴酚丁胺输注峰值时常规给予阿托品相比，早期给予阿托品可使检查持续时间缩短8%（1.1分钟，p = 0.02），多巴酚丁胺总用量减少11%（0.41 mg/kg，p = 0.02），但阿托品用量增加90%（0.36 mg，p < 0.001）。常规给予阿托品会导致心率和心率 - 血压乘积出现晚期快速上升。然而，接受早期阿托品治疗的患者的心率和心率 - 血压乘积曲线与在多巴酚丁胺负荷超声心动图检查中不需要阿托品的患者的曲线相似。总之，早期给予阿托品可提供更均衡的应激反应并缩短检查持续时间，从而减少多巴酚丁胺的总暴露量，并可能提高检查效率。
