SPECT动态分析急性心肌梗塞溶栓前后心肌灌注特点  

The evolution of myocardial perfusion in AMI following thrombolytic therapy assessed by sequential SPECT

作　　者：张水旺[1] 陈还珍[1] 李德宏[1] 张中正[1] 王陆建[1] 阎晓梅[1] 张承刚[1] 刘建中[1] 李思进[1] 李险峰[1] 

机构地区：[1]山西医科大学第一医院心内科

出　　处：《中华核医学杂志》1997年第4期224-225,共2页Chinese Journal of Nuclear Medicine

摘　　要：为观察急性心肌梗塞（ＡＭＩ）前及其后早期心肌灌注演变特点，对１５例ＡＭＩ患者注射９９ｍＴｃ甲氧基异丁基异腈后开始溶栓，然后采集ＳＰＥＣＴ数据。并于溶栓后第一周及第二周进行心肌显像，分析患者心肌灌注缺血分数。临床显示冠状动脉再通者１０例，未通者３例，不能确定者２例。１５例患者溶栓前与溶栓后第二周缺血分数差异有显著性（ｔ＝２６１，Ｐ＜００５），与溶栓后第一周缺血分数差异无显著性（ｔ＝１７７，Ｐ＞００５）。临床冠状动脉未通的３例患者溶栓前后３次检查均无改善。结果提示：ＡＭＩ溶栓前后连续进行心肌ＳＰＥＣＴ检查，不仅能动态和定量地判断冠状动脉灌注情况，评价溶栓的疗效，估计患者的预后，而且能及时发现和识别高危患者，对判断有无冠状动脉再闭塞也有一定参考价值。PURPOSE To assess the evolution of myocardial perfusion in acute myocardial infarction (AMI) following thrombolytic therapy by sequential myocardial perfusion imaging. [WT5”HZ]METHODS Fifteen patients with AMI were studied. Data of myocardial perfusion imaging with 99m Tc MIBI were collected and analysed semi quantitatively before and 1 and 2 weeks after thrombolytic therapy. RESULTS Based on the clinical data, 10 patients were reperfused following the thrombolytic therapy, 3 patients were non reperfused and 2 patients were uncertain. The myocardial perfusion defect scores of all patients before and after therapy were 28 87%±12 36%, 21 33%±11 17% (1 weeks after) and 17 73%±12 75% (2 weeks after), respectively, whereas in clinical reperfused patients were 28 60%±12 24%, 19 10%±10 07% and 14 60%±10 93%, respectively. That for patients with nonreperfused were not improved. CONCLUSIONS Sequential myocardial perfusion imaging during pre and post thrombolytic therapy could be used to assess the evolution of myocardial perfusion objectively and semi quantitatively. And it is also helpful to identify the high risk patients and to suggest further savage measures. It was also noted this proceduce had some reference value for the judgement of coronary artery restenosis.

关 键 词：心肌梗塞 AMI SPECT 溶栓疗法 

分 类 号：R542.220.4[医药卫生—心血管疾病] R816.202[医药卫生—内科学]