潘生丁负荷心肌^(201)Tl-SPECT显像预测血管外科心脏事件  

Usefulness of Dipyridamole ^(201)Tl-SPECT Imaging for Predicting Perioperative Cardiac Events in Vascular Surgery

作　　者：陈涛[1] 黄钢[1] 

机构地区：[1]上海第二医科大学新华医院核医学科

出　　处：《上海第二医科大学学报》2005年第12期1273-1276,共4页Acta Universitatis Medicinalis Secondae Shanghai

基　　金：上海市"百人计划"(97BR012)资助项目.

摘　　要：目的评价潘生丁负荷心肌^(201)Tl-SPECT显像在血管外科术前预测围术期心脏事件发生的价值。方法回顾性调查了224例连续的血管病患者术前潘生丁负荷心肌显像、临床危险因子分析以及围术期心脏事件的发生,采用多变量Logistic回归分析评价各危险因子的预测价值。结果224例患者根据临床心脏危险度分成:低(n=173)、中(n=39)和高危险组(n=12)。心肌显像可逆性缺损在高危险组明显多见于低危险组(P<0.001)。180例患者接受了血管外科手术,9例(5.0%)在围术期发生了心脏事件,其中心力衰竭1例,心绞痛2例,心律失常6例。心肌显像可逆性缺损在全体甚至在低危险患者均是唯一有效的危险预测因子(odds比:7.0和11.6,95%,可信区间:1.7~28.0和2.3~57.4,P值:0.007和0.004),其预测的灵敏度和特异性分别为:55.6%和84.8%,57.1%和89.7%。结论潘生丁负荷心肌^(201)Tl-SPECT显像对预测血管外科围术期心脏事件发生,甚至对临床低危险度的患者具有重要价值。Objective To evaluate the usefulness of dipyridamole ^201TI-SPECT imaging for predicting perioperative cardiac events in vascular surgery. Methods A retrospective investigation was performed in 224 consecutive patients with preoperative dipyridamole ^201TI-SPECT imaging, clinical risk assessment and perioperative cardiac events. A stepwise logistic regression analysis was used to estimate that predicting value in all risk factors. Results The patients were classified into low-risk （ n = 173） , intermediate-risk （ n = 39） , and high-risk （ n = 12） groups according to clinical risk stratification. The prevalence of reversible ^201TI defect was significantly higher in the highrisk group than that in the low-risk group （P 〈0. 001）. In 180 patients who underwent vascular surgery, 9 patients （5.0%） had perioperative cardiac events, including heart failure （ n = 1 ） , unstable angina （ n = 2） , and arrhythmias （n =6）. The reversible defect on ^201TI-SPECT was the only variable to predict perioperative cardiac events, even in a subgroup of low risk patients （ odds ratio 7.0 and 11.6, 95% confidence interval 1. 7 - 28.0 and 1 2.3 -57.4, P =0. 007 and P =0. 004）. The sensitivity and specificity of the reversible defect for predicting perioperative cardiac events were 55.6% and 84.8% in all operated patients, and 57.1% and 89.7% in low risk patients, respectively. Conclusion The preoperative dipyridamole ^201TI-SPECT imaging was useful for predicting perioperative cardiac events,even in low risk patients.

关 键 词：潘生丁负荷 ^201TI SPECT 围术期心脏事件 血管外科 心肌 

分 类 号：R817.4[医药卫生—影像医学与核医学] R542.2[医药卫生—放射医学]