硝酸甘油介入心肌断层显像诊断心肌梗死患者存活心肌方法的研究

Assessment of methods for detection myocardial viability in myo cardial infarction by 99m Tc MIBI with nitroglycerin intervention

目的：探讨硝酸甘油介入９９ｍ 锝－甲氧基异丁基异腈（９９ｍ Ｔｃ－ＭＩＢＩ）心肌显像估测心肌梗死（ＭＩ）患者存活心肌的价值和方法。方法：５１ 例ＭＩ患者分成急性ＭＩ（ＡＭＩ）１３ 例、陈旧性ＭＩ组１３例和ＡＭＩ溶栓组１０ 例、非溶栓组１５ 例，先行静息态９９ｍ Ｔｃ－ＭＩＢＩ心肌显像，２４ ｈ 后分别静脉和口含硝酸甘油，行介入心肌显像。结果：５１ 例行硝酸甘油介入后心肌显像表明心肌节段灌注异常较介入前有一定程度改善（７９／１４１，５６．０３％ ），硝酸甘油介入前后平均记分值分别为７．４８±２．３２、５．４５±２．１７（ Ｐ＜ ０．０１）。结论：口含硝酸甘油介入９９ｍ Ｔｃ－ＭＩＢＩ心肌显像方法简便，可有效提高ＭＩ患者存活心肌检出率。特别是溶栓治疗后ＡＭＩ患者存活心肌的检出率更高。

Objective:To research the value and methods for detection myocardial viability in myocardial infarction patients (MI) by 99m Tc MIBI with nitroglycerin intervention.Method:51 cases of MI were assessed in four groups,group 1 was acute myocardial infarction (n=13) (AMI),group 2 old myocardial infarction (n=13) (OMI),group 3 AMI with thromboclasis (n=15) and group 4 AMI without thromboclasis (n=10).The interventional 99m Tc MIBI imaging was performed with nitroglycerin by sublingual or iv nitroglycerin 24 hours after static myocardial imaging.Result:The mean score was 7.48 ± 2.32 at rest and 5.45 ± 2.17 with nitroglycerim intervention by subligual or iv nitroglycerin (P< 0.01 ).The mean score at rest was significantly different from that with nitroglycerin intervention in AMI but not significantly different in OMI.The myocardial viability was higher in group 3 that in group 4 (P< 0.01 ).Conclusion:The detection rate of myocardial viability was increased by 99m Tc MIBI with nitroglycerin intervention in MI,especially in AMI,the method was simple and reliable.