硝酸甘油介入心肌核素显像检测存活心肌的意义

Difference of viabile myocardium between acute myocardial infarction and old myocardial infarction

目的探讨急性心肌梗死(AMI)与陈旧性心肌梗死(OMI)心肌存活状态的差异。方法应用SPECT对63例Q波MI患者行常规99mTc-MIBI心肌显像(静息显像),隔日舌下含服NTG(1.0mg)后5分钟静注99mTc-MIBI,再行心肌显像(介入显像),其中4例患者行冠脉搭桥术(CABG),3例于CABG术后3月再行心肌显像。结果静息显像中239个节段灌注异常,NTG介入后有97个节段得到不同程度的改善,改善率为40.59%,静息显像平均得分为9.65±4.31,介入显像平均得分为7.75±4.66,两者比较差别有统计学意义(P<0.001)。3例CABG术前检测有改善的6个节段,术后均得到不同程度的改善。AMI组与OMI组1月-6月组,6月-3年组相比较,存活心肌的检出率分别为43.10%,42.80%,35.15%,虽呈逐渐下降,但无统计学意义(P>0.05)。结论NTG介入99mTc-MIBI心肌显像可明显提高存活心肌的检出率,且该方法简便易行,安全可靠。OMI患者亦有存活心肌,也可从血运重建中获益。

Ohjective To compare the difference of viabile myocardium between acute myocardial infarction and old myocardial infarction. Methods Technetium - ^99m - sestamibi imaging with nitroglycerin sublingual to evaluate myocardial viability in 63 patients with Q wave myocardial infarction. Results In 63 patients, 239 segnent is decreased in rest perfusion imagining, 97 segnent is improved in nitroglycerin intervention imagining, the incidence of viability myocardium is 40.59% ; 116 segments of rest imaging were identified abnormal with AMI, 50 segments（43.10% ） had improved of perfusion after NIG. 49 segments of rest imaging were idientified abnormal with OMI（ 1m - 6m）, 21 segments （42.80%） had improved of perfusion after NTG, 74 segments of rest imaging were idientifed abnormal with OMI （6m - 3y）, 26 segments （42.80%） had improved of perfusion after NTG. Viable myocardium segments decreased progressively from acute myocardial infarction to old myocardial infarction, but no significant（ P 〉 0.05）. Conclusion lmprovement the incidence of viability myocardium with Technetium-^ 99m - sestamibi imaging with nitroglycerin sublingual, myocardial viability percentages decreased progressively from acute myocardial infaction to old myocardial infaction, But no significant.