核素肺灌注显像对瓣膜性心脏病合并肺动脉高压病人的手术疗效观察  

Evaluation of pulmonary hypertension and surgical therapeutic effects using radionuclide pulmonary perfusion imaging in patients with pulmonary hypertension of valvular heart disease

作　　者：潘世伟[1] 胡盛寿[1] 许建屏[1] 王巍[1] 王雪梅[1] 柳枫[1] 冯钧[1] 何卓祥[1] 苏文君[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所成人外科,北京100037

出　　处：《中华胸心血管外科杂志》2010年第4期240-243,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨采用首次通过法核素肺灌注显像、通过放射性时间-计数曲线方法了解瓣膜性心脏病合并有肺动脉高压（PH）手术前、后肺动脉压力的变化规律的价值.方法 115例二尖瓣病变为主的瓣膜性心脏病病人均行瓣膜置换或成形术治疗.所有病人在手术前,手术后7天行核素肺灌注显像检查,33例在术后3个月进行第3次复查.另选10名健康者,测其肺循环平均时间（LET）作为正常对照组.结果 与术前相比,术后7天LET明显降低（P〈0.001）.33例术后3个月的LET与术后7天差异虽无统计学意义,但LET仍有继续下降趋势.结论 瓣膜性心脏病合并有PH病人,肺动脉压力的降低在术后7天左右最明显,此后降低缓慢.术前肺动脉压力越高,在术后早期越难以降至正常水平.无创性核素肺灌注显像检查方法在瓣膜性心脏病合并PH的术前判定、手术疗效和预后判断等方面有明显的优点和实用价值.Objective To evaluate pulmonary hypertension（PH） and surgical therapeutic effects using radionuclide pulmonary perfusion imaging in patients of valvular heart disease. Methods And material 115 patients accumulated with valvular disease were included from May 2001 to August 2007. Echocardiography and first-pass radionuclide pulmonary perfusion imaging（FPPPI） were performed in all patients before surgery,7days after surgery and 3 months after surgery（33cases）. Patients were divided into four groups. Pulmonary artery pressure （PAP） is normal group[mean pulmonary arterial pressure （MPAP）≤20mm Hg（1 mm Hg =0. 133 kPa）]; PAP slightly rise group[20 mm Hg 〈 MPAP≤30 mm Hg]; PAP moderate rise group[30 mm Hg 〈 MPAP≤50 mm Hg]; PAP weighty rise group[MPAP 〉50 mm Hg]. Results Lung Equilibrium Time （LET）by FPPPI were（18.87 ± 4.80） s, （26. 17 ± 7.09） s, （38.48 ± 7.09） s and （54.59 ± 7.96） s in this four groups before surgery. LET were 17.58 ±4.52, 21.51 ±6.44, 23.94 ±5.85, 27.29 ±6.70 in this four groups 7 days after surgery （P〈0.001）. There were no siguificantly differences of LET in 33 cases 3 months after surgery compared with those of 7 days after surgery. Conclusion Pulmonary arterial pressure siguificantly decreased 7 days after surgery in patients with PH of valvular heart disease, especially in those of slightly and moderate rise groups. FPPPI is an accuracy method in evaluating surgical therapeutic effects in valvular heart disease.

关 键 词：心脏瓣膜疾病 心血管造影术 同位素标记 肺动脉高压 核素肺灌注显像 

分 类 号：R654.2[医药卫生—外科学]