硝酸甘油酯介入^(99m)Tc-MIBI心肌断层显像与多巴酚丁胺负荷超声心动图判定存活心肌的比较  

Identification of viable myocardium by nitroglycerin 99m Tc MIBI myocardial tomography in patients with acute myocardial infarction and comparison with echocardiography during infusion of dobutamine

作　　者：王铁[1] 刘晓惠[1] 张金谷[1] 吴雅峰[1] 郑柏洁[1] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院核医学科

出　　处：《中华核医学杂志》1997年第3期143-145,共3页Chinese Journal of Nuclear Medicine

摘　　要：为比较硝酸甘油酯（ＮＴＧ）介入９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与小剂量多巴酚丁胺负荷超声心动图（ＤＳＥ）在判断急性心肌梗塞（ＡＭＩ）后病人存活心肌中的一致性，对３６例ＡＭＩ病人分别进行了ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像和小剂量（＜１０μｇ·ｋｇ－１·ｍｉｎ－１）的ＤＳＥ检查，所有检查均在病人入院后２～３周内完成。结果：在心肌静态显像示梗塞的１０９个节段中，ＮＴＧ显像４３个为存活节段，存活心肌检出率为３９％；在基础状态下超声心动图示梗塞的９４个节段中，ＤＳＥ检查３５个为存活节段，其存活心肌检出率为３７％，两者间差异无显著性（χ２＝０１０５，Ｐ＞００５）。在两法共同检出的９２个梗塞节段中，均存活的节段为２９个，均未存活的节段为４９个，两法的一致性为８４８％（７８／９２，Κ＝０６８）。因此，ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像与ＤＳＥ检查均为判断ＡＭＩ后病人存活心肌的安全、可靠的方法，两法具有良好的一致性。PURPOSE To evaluate the concordance between nitroglycerin (NTG) 99m Tc MIBI myocardial tomography and dobutamine echocardiography (DSE) in detecting viable myocardium of the patients with acute myocardial infarction (AMI) METHODS 36 patients with AMI were studied using NTG 99m Tc MIBI SPECT and echocardiography during infusion of dobutamine in order to identity myocardial viability All subjects underwent NTG 99m Tc MIBI SPECT and DSE within 3 weeks after infarction RESULTS Out of 109 segments with nonperfusion in rest SPECT, 43 segments (39%) had improvement of perfusion in NTG 99m Tc MIBI SPECT, 94 segments with nonkinesis at baseline, after dobutamine infusion by 10μg·kg -1 ·min -1 , 35 segments (37%) became normokinetic or hypokinetic There was no significant difference between NTG 99m Tc MIBI SPECT and DSE (χ 2=0 105, P>0 05) In 92 segments detected by both techniques: 29 segments were viable and 49 segments were nonviable There was a good concordance between the two techniques 84 8%(78/92),Κ=0 68 CONCLUSIONS NTG 99m Tc MIBI myocardial tomography and echocardiography during infusion of low dose dobutamine is a safe and reliable method for identifying myocardial viability after AMI A good concordance between two techniques was observed

关 键 词：心肌梗塞 三硝酸基油酯 锝 超声心动图 

分 类 号：R542.22[医药卫生—心血管疾病]