^(99)m锝-甲氧基异丁基心肌显像对急性心肌梗死静脉溶栓治疗效果的评价

The assessment of single photon emission computed tomography with ^(99m)Tcmethoxy isobutyl isonitrile and echocardiography on intravenous thrombolytic therapy of acute myocardial infarction

目的：探讨静脉溶栓治疗对急性心肌梗死（ＡＭＩ）后心肌缺血和室壁运动障碍的影响，及９９ｍ锝甲氧基异丁基（９９ｍＴｃＭＩＢＩ）心肌显像的应用价值。方法：２３例ＡＭＩ患者，其中溶栓再灌注组１２例，无再灌注组１１例。患者在溶栓前及发病后５日～７日行９９ｍＴｃＭＩＢＩ心肌显像，发病３日～７日内行二维超声心动图检查，并随访４个月后的室壁运动状况。结果：２组患者首次心肌显像心肌缺损得分和基础室壁运动得分指数均无显著性差异（Ｐ均＞０．０５）。再灌注组第２次心肌显像心肌缺损得分（５．０±２．６）显著低于第１次得分（１６．３±３．９，Ｐ＜０．０１），缺损得分减少７０．２％±１０．８％；随访期室壁运动得分指数（１．１２±０．１６）显著低于基础指数（１．４７±０．１２，Ｐ＜０．０１）。无再灌注组２次心肌显像心肌缺损得分、随访期和基础室壁运动得分指数均无显著性差异（Ｐ均＞０．０５）。结论：早期静脉溶栓可挽救濒死心肌，缩小梗死面积，改善心功能；９９ｍＴｃＭＩＢＩ心肌灌注断层显像是判断心肌梗死范围、评价溶栓效果的较好手段。

Objective:To explore the effects of intravenous thrombolytic therapy on myocardial ischemia and retricular wall motion in patients with acute myocardial infarction(AMI),and to investigate the value of using single photon emission computed tomography (SPECT) with ^(99m)Tcmethoxy isobutyl isonitrile ( ^(99m)TcMIBI).Methods:Twentythree patients with AMI were divided into reperfusion group (12 cases) and nonreperfusion group (11 cases).SPECT with ^(99m)TcMIBI was performed before thrombolytic therapy and 5 to 7 days later.Twodimension echocardiography (2 DE) was performed in 3 to 7 days and repeated 4 months later.SPECT and 2ED studies were evaluated using an uptake score.Results:SPECT defect score and ventricular wall motion score indices were similar the first time in 2 groups (both P>0.05).SPECT defect score and ventricular wall motion score indices were significantly lower in the second time compared with the first time in reperfusion group (P<0.01).The percent decrease of the uptake defects was 702%±108%.But SPECT defect score and ventricular wall motion score indices were similar between 2 events in nonreperfusion group (P>005).Conclusions:Earlier intravenous thrombolytic therapy should save dying myocardium and shrink the infarct size to improve heart function.SPECT with ^(99m)TcMIBI was a good method for evaluation of the infarct size and thrombolytic effects.