Wysokinski W E, Spittell P C, Pellikka P A, Miller W L, Seward J B
Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Int Angiol. 1998 Sep;17(3):201-7.
This study was designed to evaluate the effect of short-term administration of graded dose of dobutamine on the circulation of the lower limbs in the patients with symptomatic peripheral arterial occlusive disease.
An ankle-brachial pressure index (ABI) was determined at the time of dobutamine stress echocardiography by measuring systolic pressure over the brachial artery and right dorsalis pedis artery using continuous-wave Doppler instrument. Setting. The study was conducted on all patients who had dobutamine stress echocardiography ordered by their referring physicians and performed in the Echocardiography Laboratory of the Mayo Clinic. Patients. All patients scheduled for dobutamine stress echocardiography were the subject of this study unless they had rigid vessels defined as ABI > 1.5, were on beta-blockers or did not agree to participate in the study. 20 patients, mean age 67 +/- 9 years (9 men and 11 women) without peripheral occlusive arterial disease and resting ABI > or = 1.0 (group A), and 18 patients, mean age 71 +/- 10 years (11 men and 7 women) with the evidence of peripheral occlusive arterial disease and ABI < 1.0 were examined. Measures. ABI was measured just prior to starting the dobutamine infusion, and then at the third minute of each increment in dobutamine dosage.
In control group patients ABI rises at 5-10 micrograms/kg/min of dobutamine infusion and at higher doses (20-50 micrograms/kg/min) drops back to the baseline values. In the patients with peripheral arterial occlusive disease low doses of dobutamine do not increase ABI, but higher doses cause decrease of pressure index from 0.6 to 0.3. There was no incidence of ischemic pain or any other kind of discomfort in the lower extremities.
Low doses of dobutamine have no decremental effect on peripheral circulation. High doses of dobutamine cause a profound decrease of blood pressure in the lower limbs of patients with peripheral occlusive arterial disease, and the extent of decrease was proportional to the degree of ischemia. Peripheral blood pressure changes registered in the study over dorsalis pedis artery at the time of dobutamine infusion resemble those that occurred at the time of exercise-walking test. ABI measurement at the time of dobutamine echocardiography might be a useful test for the evaluation of peripheral circulation. Further studies are necessary for the assessment of a clinical usefulness of dobutamine-ankle-brachial test.
本研究旨在评估短期给予不同剂量多巴酚丁胺对有症状的外周动脉闭塞性疾病患者下肢循环的影响。
在多巴酚丁胺负荷超声心动图检查时，使用连续波多普勒仪测量肱动脉和右足背动脉的收缩压，以确定踝臂压力指数（ABI）。设置。本研究对所有由转诊医生安排进行多巴酚丁胺负荷超声心动图检查并在梅奥诊所超声心动图实验室进行检查的患者进行。患者。所有计划进行多巴酚丁胺负荷超声心动图检查的患者均为本研究对象，除非他们有定义为ABI>1.5的僵硬血管、正在服用β受体阻滞剂或不同意参与本研究。20名平均年龄67±9岁（9名男性和11名女性）且无外周动脉闭塞性疾病且静息ABI≥1.0的患者（A组），以及18名平均年龄71±10岁（11名男性和7名女性）且有外周动脉闭塞性疾病证据且ABI<1.0的患者接受了检查。测量。在开始多巴酚丁胺输注前测量ABI，然后在多巴酚丁胺剂量每次增加的第三分钟测量。
在对照组患者中，多巴酚丁胺输注速度为5 - 10微克/千克/分钟时ABI升高，而在更高剂量（20 - 50微克/千克/分钟）时降至基线值。在外周动脉闭塞性疾病患者中，低剂量多巴酚丁胺不会增加ABI，但高剂量会导致压力指数从0.6降至0.3。下肢未发生缺血性疼痛或任何其他不适。
低剂量多巴酚丁胺对外周循环无递减作用。高剂量多巴酚丁胺会导致外周动脉闭塞性疾病患者下肢血压显著下降，且下降程度与缺血程度成正比。本研究中在多巴酚丁胺输注时在足背动脉记录的外周血压变化类似于运动步行试验时发生的变化。多巴酚丁胺负荷超声心动图检查时的ABI测量可能是评估外周循环的有用检查。需要进一步研究以评估多巴酚丁胺 - 踝臂试验的临床实用性。
