药物介入核素心肌显像在识别存活心肌中的作用

Emission computed tomography of drug injection on detecting viable myocardium

目的:研究核素心肌显像在识别存活心肌中的准确性及实用性。方法 :对 2 0 0 0年 10月～ 2 0 0 1年 9月行 PTCA+支架术的 30例住院心肌梗死患者 (梗塞后 2周至 3个月 ) ,采用 PTCA支架术前静点小剂量多巴酚丁胺 (3μg· kg- 1· min- 1 ) ,并合用舌下含服硝酸甘油 (0 .5 m g) 99m TC- MIBI心肌显像 ,与术后 3周时复查静息 99m TC-MIBI心肌显像进行对比 ,观察多巴酚丁胺与硝酸酯合用预测存活心肌的准确度及安全性。结果:PTCA支架术前静息 99m Tc- MIBI心肌灌注显像共有 117个节段心肌摄取异常。药物介入 99m Tc- MIBI心肌灌注显像及 PTCA支架术后 3周静息 99m Tc- MIBI心肌灌注显像放射性分布异常节段心肌血流灌注改善。术前静息心肌灌注显像的 117个节段 ,药物介入 99m Tc- MIBI心肌灌注显像有 4 1个节段灌注改善 ,2 3个节段正常 ,5 3个节段无变化。PTCA支架术后 3周随访中有 4 8个节段改善 ,2 8个节段正常 ,无效的 5 3个节段在 PTCA支架术后有 4 1个节段心肌灌注无改善。结论 :以 PTCA支架术后 3周为标准 ,静脉应用小剂量多巴酚丁胺时舌下含服硝酸甘油 (0 .5 m g)核素心肌显像 ,预测存活心肌灵敏度为 84 .2 % ,特异度为 77.4 % ,具有安全性高、副作用小。

Objective: To study the accuracy and practicality of ECT in identifying viable myocardium. Methods: From Oct. 2000 to Sep. 2001,30 patients who suffered myocardial infarction and underwent PCI operation accepted 99m Tc MIBI myocardial tomography with low dose dobutamine (3 μg/kg/min) and sublingual nitroglycerin (0.5 mg) before PCI operation. All patients were studied by rest imaging three weeks after operation, and observed the accuracy and safety of using dobutamine and nitroglycerin together for detecting the viable myocardium. Results: There were 117 segments of hypoperfusion in rest imaging before operation. There was improvement in the myocardium perfusion of hypoperfusive cases after using drug imaging and PCI operation. The results showed that 41 segments had improvement, 23 segments had normal uptake, and 53 segments had no change after drugs. During three follow up weeks after operation, 48 segments had improvement, 28 segments had normal uptake. 41 segments had no improvement in 53 segments that had no change formerly. There were improvement of 12 segments within inefficient 53 segments after operation. According to the criterion of PCI after 3 weeks, the sensitivity was 84.2%, and the specificity was 77.4% of 99m Tc MIBI myocardial tomography after injected low dose dobutamine and sublingual nitroglycerin. Conclusion: The sensitivity was 84.2%, and the specificity was 77.4% of 99m Tc MIBI myocardial tomography after injected low dose dobutamine and sublingual nitroglycerin. And the method is safe as well as accepted easily by patients.