核素心肌灌注显像评估关节置换患者围手术期心脏风险的临床应用

Clinic value of myocardiac perfusion imaging in coronary risk assessment in patients planning total joint arthroplasty

目的 探讨核素心肌灌注显像（myocardiac perfusion imaging,MPI）在合并心血管疾病拟行关节置换患者中评估围手术期冠脉缺血的临床应用价值,对比分析MPI和冠脉CT造影（computed tomography angiogram,CTA）对冠脉评估一致性及对手术计划的影响.方法 前瞻性收集合并心血管疾病拟行关节置换的患者病例资料,行MPI及CTA检查,根据MPI评估心肌血流灌注情况决定是否手术,统计分析MPI及CTA对冠脉评估的一致性和对手术计划的影响,并记录术后心血管并发症情况.结果 共纳入228例患者,男97例,女131例;年龄53 ～ 88岁,平均73.2岁.MPI未发现心肌缺血215例,发现不同程度心肌缺血13例.无心肌缺血患者CTA检查显示：113例无冠脉狭窄,51例轻度冠脉狭窄,39例中度冠脉狭窄,12例重度冠脉狭窄.心肌缺血患者CTA检查显示3例无冠脉狭窄,4例轻度冠脉狭窄,3例中度冠状动脉狭窄,3例重度冠脉狭窄,MPI和CTA检查对冠脉评估的一致性较差.222例患者按计划实施手术,6例患者取消手术,MPI检查结果对手术计划有明显影响,而CTA检查结果对手术计划无明显影响.术后无心肌缺血相关的心绞痛、心肌梗塞及心源性死亡病例,心血管并发症包括6例心衰,4例房颤及1例脑梗塞.结论 MPI是冠脉缺血评价的直接指标,能够准确预测围手术期冠脉缺血风险及预后,可筛选出需要延迟或禁忌手术的病例,对于临床手术计划的取舍具有重要参考意义,有助于降低并发症、提高围手术期安全性.

Objective To explore clinic value of nuclear myocardiac perfusion imaging （MPI） in perioperative coronary risk assessment in patients with heart diseases planning arthroplasty,and compare the conformity and effect on surgery planning between MPI and coronary computed tomography angiogram （CTA）.Methods Prospectively collect clinical data of 228 patients with heart diseases planning joint arthroplasty,all patients had MPI and CTA test to assess perioperative coronary risk.The conformity and effect on surgery planning between the MPI and CTA was analyzed,and the occurrence of cardio-vascular complication was recorded.Results MPI showed that 215 patients had no myocardial ischemia except for 13.CTA showed that 113 cases had no coronary stenosis,51 cases had light coronary stenosis,39 cases had middle coronary stenosis and 12 cases had severe coronary stenosis in patients with no myocardial ischemia.CTA also found that 3 cases had no coronary stenosis,4 cases had light coronary stenosis,3 cases had middle coronary stenosis and 3 cases had severe coronary stenosis in patients with myocardial ischemia.The conformity between MPI and CTA was low.222 patients had completed operation except for 6 cases.MPI rather than CTA had conspicuous effect on surgery planning.There was no angina,myocardial infarction or cardiac death associated with myocardial ischemia.The postoperative cardio-vascular complications included 6 cases of heart failure,4 cases of atrial fibrillation and 1 case of cerebral infarction.Conclusion MPI is a direct index to judge blood supply of the myocardium,which can exactly predict the risk of perioperative myocardial ischemia and the prognosis.It＆#39;s helpful for preoperative planning,reducing risk of perioperative complications through screening and excluding high-risk patients.