肺通气/灌注显像对肺栓塞疗效的评价

The value of lung ventilation-perfusion scintigraphy in monitoring therapeutic effects in pulmonary embolism

目的探讨肺通气/灌注(V/Q)显像在观察肺栓塞(PE)溶栓和抗凝治疗效果中的价值。方法对65例抗凝和溶栓治疗的PE患者,治疗前后分别给予^(99)Tc^m气体37～74 MBq和^(99)Tc^m-聚合白蛋白(MAA)148～185 MBq后行8个体位V/Q显像;并在治疗后不同时间多次重复V/Q显像。结果44例PE患者296个受损肺段,单纯抗凝治疗1年半内,V/Q显像显示106个肺段恢复正常(35．8%),69个受损肺段改善(23．3%),121个肺段无改善(40．9%)。21例PE患者165个受损肺段,溶栓结合抗凝治疗后V/Q显像示有85个肺段恢复正常(51．5%),有29个肺段改善(17．6%),有51个肺段无改善(30．9%)。其中在PE发病7 d内治疗效果最佳,单纯抗凝治疗7 d与14 d疗效之间比较及溶栓结合抗凝治疗7 d与14 d疗效之间比较,差异均有统计学意义(X^2=8．79和56．31,P＜0．05和＜0．01)。结论V/Q显像能较好地评价PE抗凝和溶栓治疗效果。

Objective Lung ventilation-perfusion （V/Q） scintigraphy was an effective way in the evaluation of therapeutic effects of anticoagulation and thrombolysis for pulmonary embolism （PE）. Methods Lung ^99Tc^m-Technegas ventilation and ^99Tc^m-macro-aggregated albumin （MAA） perfusion scintigraphy was performed before and after treatment and repeated in different observation period in 65 cases with PE. Results Among 296 abnormal pulmonary segments in 44 cases with PE, 106 segments （35.8%） were found back to normal after anticoagulation treatment for 1.5 years, with 69 （23.3%） improved and 121 （40.9%） no change. Among 165 abnormal pulmonary segments in 21 cases with PE, 85 segments （51.5%） were normal after anticoagulation and thrombolysis treatment, with 29 improved （ 17.6% ） and 51 no change （30.9%）. The statistical significant difference was found in patients treated with anticoagulation, anticoagulation and thrombolysis after 7 and 14 d, respectively （χ^2 = 8.79 and 56.31, P 〈 0.05 and 〈 0.01 ）. Conclusion Lung V/Q scintigraphy has great value in monitoring the therapeutic effects of anticoagulation and thrombolysis.