• 四川大學(xué)華西醫(yī)院 麻醉科,成都 610041;

目的 利用組織多普勒應(yīng)變率技術(shù)評(píng)估心瓣膜置換術(shù)患者使用小劑量多巴胺、米力農(nóng)對(duì)其左心室收縮及舒張功能的影響?!》椒ā∵x擇2011年3~5月四川大學(xué)華西醫(yī)院擇期行心瓣膜置換術(shù)患者共40例,將其隨機(jī)分為米力農(nóng)組(20例)和多巴胺組(20例),于麻醉誘導(dǎo)后、體外循環(huán)前測(cè)量兩組患者左心室射血分?jǐn)?shù)(LVEF),應(yīng)用組織多普勒應(yīng)變率技術(shù)測(cè)定四腔心切面左心室側(cè)壁、間壁的組織,并對(duì)多普勒參數(shù)進(jìn)行比較?!〗Y(jié)果 兩組患者 LVEF、左心室舒張?jiān)缙诤褪鎻埻砥谘鞅戎担‥/A)、左心室舒張?jiān)缙谘骱褪鎻堅(jiān)缙谛募∵\(yùn)動(dòng)峰值的比值(E/Et)給藥前后差異有統(tǒng)計(jì)學(xué)意義 (P<0.05);米力農(nóng)組有4個(gè)節(jié)段收縮期峰值速度(Vs),1個(gè)節(jié)段舒張?jiān)缙诜逯邓俣龋╒e),4個(gè)節(jié)段舒張晚期峰值速度(Va),3個(gè)節(jié)段Ve/Va比值,2個(gè)節(jié)段收縮期峰值應(yīng)變率(SRs),2個(gè)節(jié)段舒張晚期峰值應(yīng)變率(SRa),3個(gè)節(jié)段舒張?jiān)缙诜逯祽?yīng)變率(SRe)/SRa比值高于給藥前 (P<0.05);多巴胺組有4個(gè)節(jié)段Vs,1個(gè)節(jié)段Ve,4個(gè)節(jié)段Va,1個(gè)節(jié)段Ve/Va比值,2個(gè)節(jié)段SRs,1個(gè)節(jié)段SRe,1個(gè)節(jié)段SRa,1個(gè)節(jié)段SRe/SRa比值高于給藥前 (P<0.05)。兩組間比較,給藥后米力農(nóng)組有2個(gè)節(jié)段Vs,4個(gè)節(jié)段Va,1個(gè)節(jié)段SRe ,1個(gè)節(jié)段SRa,2個(gè)節(jié)段Ve/Va比值,2個(gè)節(jié)段SRe/SRa比值高于多巴胺組(P<0.05);其中1個(gè)節(jié)段Vs,2個(gè)節(jié)段SRs低于多巴胺組,E/A比值給藥10 min時(shí),E/Et比值給藥20 min時(shí)低于多巴胺組?!〗Y(jié)論 運(yùn)用組織多普勒應(yīng)變率技術(shù)評(píng)估米力農(nóng)、多巴胺均能改善心瓣膜置換術(shù)患者圍術(shù)期左心室收縮功能,其中米力農(nóng)對(duì)左心室長軸舒張功能的改善較多巴胺明顯。

引用本文: 李霞,彭玲,魏蔚. 應(yīng)用組織多普勒應(yīng)變率技術(shù)評(píng)價(jià)米力農(nóng)、多巴胺對(duì) 心臟瓣膜手術(shù)患者左心室功能的作用. 中國胸心血管外科臨床雜志, 2013, 20(1): 43-48. doi: 復(fù)制

1.  Weidemann F, Jamal F, Sutherland GR, et al. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol, 2002, 283 (2): H792-H799.
2.  Bayram M, De Luca L, Massie MB, et al. Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes. Am J Cardiol, 2005, 96 (6A): 47G-58G.
3.  Kikura M, Levy JH, Michelsen LG, et al. The effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass. Anesth Analg, 1997, 85 (1): 16-22.
4.  Yamada T, Takeda J, Katori N, et al. Hemodynamic effects of  milrinone during weaning from cardiopulmonary bypass:  comparison of patients with a low and high prebypass cardiac index. J  Cardiothorac Vasc Anesth, 2000, 14 (4): 367-373.
5.  張曉慶, 杭燕南, 孫大金. 米力農(nóng)聯(lián)合多巴胺用于重癥心內(nèi)直視術(shù)停機(jī)過程. 臨床麻醉學(xué)雜志, 2000, 7 (7):328-331..
6.  Barraud D, Faivre V, Damy T, et al. Levosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits: comparison with dobutamine and milrinone. Crit Care Med, 2007, 35 (5): 1376-1382.
7.  Couture P, Denault AY, Pellerin M, et al. Milrinone enhances  systolic, but not diastolic function during coronary artery bypass grafting surgery. Can J Anaesth, 2007, 54 (7):509-522.
8.  Axelsson B, Arbeus M, Magnuson A, et al. Milrinone improves diastolic function in coronary artery bypass surgery as assessed by acoustic quantification and peak filling rate: a prospective randomized study. J Cardiothorac Vasc Anesth, 2010, 24 (2): 244-249.
9.  Price DJ, Wallbridge DR, Stewart MJ. Tissue doppler imaging: current and potential clinical applications. Heart, 2000, 84 (Suppl Ⅱ): Ⅱ11-Ⅱ18.
10.  Meluzín J, Spinarová L, Bakala J, et al. Pulsed doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular  systolic function. Eur Heart J, 2001, 22 (4): 340-348.
11.  Dae-Won S, In-Ho C, LEE Dong-jun, et al. Assessment of mitral annulus velocity by doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol, 1997, 30 (2): 474-480.
12.  Oh JK, Hatle L, Tajik AJ, et al. Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography. J Am Coll Cardiol, 2006, 47 (3): 500-506.
13.  Y?lmaz O, Ceylan O, Orün UA, et al. Assessment of left ventricular  functions with tissue Doppler, strain and strain rate echocardiography in children with juvenile idiopathic arthritis: An observational study. Anadolu Kardiyol Derg, 2012, 12 (4): 339-346.
14.  Sim?ek Z, Karakelleo?lu S, Gündo?du F, et al. Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis. Anadolu Kardiyol Derg, 2010, 10 (4):328-333.
15.  Simsek Z, Gundogdu F, Alpaydin S, et al. Analysis of athletes'  heart by tissue Doppler and strain/strain rate imaging. Int J  Cardiovasc Imaging, 2011, 27 (1): 105-111.
16.  Tümüklü MM, Etikan I, Cinar CS. Left ventricular function in  professional football players evaluated by tissue Doppler imaging and strain imaging. Int J Cardiovasc Imaging, 2008, 24 (1): 25-35.
17.  梁曉霞, 蘆芳, 趙敏. 斑點(diǎn)追蹤成像技術(shù)評(píng)價(jià)心力衰竭左室心肌應(yīng)變的價(jià)值. 中西醫(yī)結(jié)合心腦血管病雜志,2009,7 (5):517-518.
18.  Koyama J, Ray-Sequin PA, Falk RH. Longitudinal myocardial function assessed by tissue velocity, strain, and strain rate tissue Doppler echocardiography in patients with AL (primary) cardiac amyloidosis. Circulation, 2003, 107 (19): 2446-2452.
  1. 1.  Weidemann F, Jamal F, Sutherland GR, et al. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol, 2002, 283 (2): H792-H799.
  2. 2.  Bayram M, De Luca L, Massie MB, et al. Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes. Am J Cardiol, 2005, 96 (6A): 47G-58G.
  3. 3.  Kikura M, Levy JH, Michelsen LG, et al. The effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass. Anesth Analg, 1997, 85 (1): 16-22.
  4. 4.  Yamada T, Takeda J, Katori N, et al. Hemodynamic effects of  milrinone during weaning from cardiopulmonary bypass:  comparison of patients with a low and high prebypass cardiac index. J  Cardiothorac Vasc Anesth, 2000, 14 (4): 367-373.
  5. 5.  張曉慶, 杭燕南, 孫大金. 米力農(nóng)聯(lián)合多巴胺用于重癥心內(nèi)直視術(shù)停機(jī)過程. 臨床麻醉學(xué)雜志, 2000, 7 (7):328-331..
  6. 6.  Barraud D, Faivre V, Damy T, et al. Levosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits: comparison with dobutamine and milrinone. Crit Care Med, 2007, 35 (5): 1376-1382.
  7. 7.  Couture P, Denault AY, Pellerin M, et al. Milrinone enhances  systolic, but not diastolic function during coronary artery bypass grafting surgery. Can J Anaesth, 2007, 54 (7):509-522.
  8. 8.  Axelsson B, Arbeus M, Magnuson A, et al. Milrinone improves diastolic function in coronary artery bypass surgery as assessed by acoustic quantification and peak filling rate: a prospective randomized study. J Cardiothorac Vasc Anesth, 2010, 24 (2): 244-249.
  9. 9.  Price DJ, Wallbridge DR, Stewart MJ. Tissue doppler imaging: current and potential clinical applications. Heart, 2000, 84 (Suppl Ⅱ): Ⅱ11-Ⅱ18.
  10. 10.  Meluzín J, Spinarová L, Bakala J, et al. Pulsed doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular  systolic function. Eur Heart J, 2001, 22 (4): 340-348.
  11. 11.  Dae-Won S, In-Ho C, LEE Dong-jun, et al. Assessment of mitral annulus velocity by doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol, 1997, 30 (2): 474-480.
  12. 12.  Oh JK, Hatle L, Tajik AJ, et al. Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography. J Am Coll Cardiol, 2006, 47 (3): 500-506.
  13. 13.  Y?lmaz O, Ceylan O, Orün UA, et al. Assessment of left ventricular  functions with tissue Doppler, strain and strain rate echocardiography in children with juvenile idiopathic arthritis: An observational study. Anadolu Kardiyol Derg, 2012, 12 (4): 339-346.
  14. 14.  Sim?ek Z, Karakelleo?lu S, Gündo?du F, et al. Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis. Anadolu Kardiyol Derg, 2010, 10 (4):328-333.
  15. 15.  Simsek Z, Gundogdu F, Alpaydin S, et al. Analysis of athletes'  heart by tissue Doppler and strain/strain rate imaging. Int J  Cardiovasc Imaging, 2011, 27 (1): 105-111.
  16. 16.  Tümüklü MM, Etikan I, Cinar CS. Left ventricular function in  professional football players evaluated by tissue Doppler imaging and strain imaging. Int J Cardiovasc Imaging, 2008, 24 (1): 25-35.
  17. 17.  梁曉霞, 蘆芳, 趙敏. 斑點(diǎn)追蹤成像技術(shù)評(píng)價(jià)心力衰竭左室心肌應(yīng)變的價(jià)值. 中西醫(yī)結(jié)合心腦血管病雜志,2009,7 (5):517-518.
  18. 18.  Koyama J, Ray-Sequin PA, Falk RH. Longitudinal myocardial function assessed by tissue velocity, strain, and strain rate tissue Doppler echocardiography in patients with AL (primary) cardiac amyloidosis. Circulation, 2003, 107 (19): 2446-2452.