下消化道出血核素显像的临床价值及其影响因素分析  

Clinical value of ^(99m)Tc-RBC imaging in patients with lower digestive tract bleeding and analysis of influencing factors

作　　者：尹丰[1] 占宏伟[1] 刘洪彪[1] 许唯[1] 叶小娟[1] 何刚强[1] 张宏[1] 孙达[1] 

机构地区：[1]浙江大学医学院附属第二医院核医学科,杭州310009

出　　处：《浙江医学》2008年第1期17-18,81,共3页Zhejiang Medical Journal

摘　　要：目的探讨核素显像在下消化道出血定位诊断中的应用价值及影响检查结果的因素,为临床准确应用该方法来提高诊断效率提供依据。方法68例下消化道出血患者进行99mTc-RBC显像,观察显像结果,采用Logistic多因素回归分析了解患者性别、年龄、慢性病史、检查时血流动力学指标是否稳定、检查前4h血便次数、以前消化道出血史、是否正在进行止血治疗等因素间的关系,并将核素显像定位结果与患者手术、DSA或肠镜检查结果进行比较。结果(1)核素显像发现有活动性消化道出血者30例,阳性率为44.1%;检查前便血次数多者易出现阳性结果,检查前正在进行止血治疗者易出现阴性结果。(2)23例诊断明确的核素显像阳性患者,核素显像定位基本准确18例,定位准确率为78.3%,其中小肠出血的准确率为81.3%(13/16),结肠出血的准确率为71.4%(5/7)。结论核素显像可以初步确定下消化道出血部位,为临床进一步处理提供帮助;检查时患者是否处于出血期是影响核素显像阳性率的主要因素。Objective To investigate the clinical value of ^99mTc-RBC imaging in patients with lower digestive tract bleeding and its influencing factors. Methods ^99mTc-RBC imaging was performed in 68 patients with lower digestive tract bleeding. The examine results were analyzed with of sex, age, chronic medical history, stability of blood dynamics, the number of melaena or enterorrhagia episodes in 4 hours before imaging, former bleeding history of gastrointestinal tract, and therapeutic intervention for bleeding. The results of imaging were also compared with the those of surgery, DSA or colonoscopy. Results There were 30 patients with positive result of ^99mTc-RBC imaging with a positive rate of 44.1%. Logistic regression analysis showed that the number of melaena or enterorrhagia episodes and therapeutic intervention for bleeding were significantly different between patients with positive and negative results. The bleeding site was confirmed in 18 of 23 patients with a accurate rate of 78.3%. Conclusion ^99mTc-RBC imaging is the effective method to localize lower digestive tract bleeding, and the current episode of bleeding during imaging is the major influencing factor on the positive rate of imaging.

关 键 词：下消化道出血 定位 ^99mTc—RBC 显像 

分 类 号：R574.9[医药卫生—消化系统] R817.4[医药卫生—内科学]