国产腺苷负荷实验在核素心肌血流灌注显像中的应用

Application of adenosine(produced in China) stress test in nuclear myocardial perfusion imaging

目的评价国产腺苷负荷实验在核素心肌血流灌注显像中的安全性及对冠心痛的诊断价值，以及用药产生的主要不良反应。方法采用国产腺苷对50例临床确诊或疑诊为冠·,12病患者行腺苷负荷或腺苷负荷／静息^99m Tc—MIBI心肌血流灌注断层显像，腺苷以0．14mg·kg^-1·min^-1采用三通静脉泵入，泵药3min末时静脉推注”^99Tc—MIBI 925MBq，共6min，用药开话至停药后5min全程监护心电图、血压．注射^99Tc—MIBI后1～1．5h采集图像，对心肌血流灌注断层显像进行定性分析。结果（1）总的症状性不良反应发生率68％，主要表现为气促、心悸、头昏、胸闷、心前区不适等，上述症状可出现一种或多种并发。（2）用药前后心电图改变26例，主要以T波倒置、一过性房室传导阻滞为主。（3）血流动力学方面，用腺苷第1分钟内心率、血压变化不明显，第3分钟心率增加到（17±4）次／分，42例患者收缩压平均降低12mmHg（1mmHg=0．133kPa），舒张压平均降低8～10mmHg。停药3min心率、血压基本恢复到用药前水平，不良反应完全消失。腺苷负荷核素心肌血流灌注显像结果与已行的冠状动脉造影符合率7s％。结论国产腺苷虽一般不良反应发生率较高，但临床表现轻，持续时间短，多无需特殊处理。患者耐受性好,临床应用安全，腺苷负荷实验核素心肌血流灌注显像诊断冠心病敏感性及特异性均较高，作为一种无创性检查具有重要的临床应用价值。

Objective To evaluate the safety and adverse effects of adenosine nuclear myocardial perfusion stress test and to assess its value in diagnosis of coronary artery disease, Methods Adenosine stress test was performed in 50 patients with confirmed or possible coronary artery disease, Myocardial perfusion imaging was obtained using ^99mTc-MIBI. The adenosine was given at 0.14mg·kg^-1·min^-1 intravenously for 6minutes. ^99m Tc-MIBI was given intravenously at 3minutes after adenosine infusion was started. Electrocardiography and pressure monitoring was performed during the stress test and 5minutes after the discontinuation of adenosine. Myocardial perfusion imaging was obtained 1--1.5 hours after the injection of ^99mTc-MIBI and images were analyzed, Results （1） Incidence of adverse effects was 68% including dyspnea,palpitation,dizziness,chest pressure and（or） chest discomfort, Patients might have one or more above symptoms. （2）Twenty-six patients had changes in electrocardiogram,mainly inversion of T wave and transient atrioventriuclar block. （3）There were no significant changes in heart rate and blood pressure （hemodynamic） in the firstminute after adenosine infusion, However, the heart rate increased by （17 ±4）beat/rain and systolic pressure reduced by 12ram Hg（1mm Hg=0. 133kPa）, in 3 minutes after the adenosine infusion. The heart rate and blood pressure returned to the baseline and symptoms resolved in 3 minutes after the discontinuation of adenosine infusion, Myocardial perfusion imaging was consistent with the findings of coronary angiograms in 75% of patients. Conclusion Relatively high Incidence of adverse effects was observed in adenosine stress test （adenosine produced in China）, Symptoms were often transient and well tolerated by patients, The adenosine stress test may be safely used in clinic, Adenosine stress nuclear myocardial perfusion imaging has relatively high sensitivity and specificity for diagnosis of coronary artery disease, As a noninvasive diagnosis tool,adenosine stress nuclear myocardial perfusion imaging may have an important clinical application.