急性心肌梗死部位的心肌存活性评价  

Identification of viable myocardium in the infarcted regions by low-dose dobutamine stress echocardiography and quantitative Tc 99m MIBI tomoscintigraphy at rest

作　　者：赵锋[1] 顾复生[1] 王安安[1] 李春林[1] 陈道荫[1] 宁静[1] 滕一星[1] 沈爱东[1] 

机构地区：[1]首都医科大学附属北京友谊医院,100050

出　　处：《中华心血管病杂志》2000年第5期349-351,共3页Chinese Journal of Cardiology

摘　　要：目的　研究急性心肌梗死 (AMI)部位的心肌存活性。方法　对 34例AMI患者 (溶栓开通 14例 ,未开通 3例 )进行了低剂量多巴酚丁胺负荷超声心动图和静息态定量Tc 99mMIBI单光子发射断层 (SPECT)检查。结果　采用 16段分段法 ,在全部 5 44个节段中 ,有 172个AMI节段 ,其中具有心肌存活性的节段在溶栓开通组和未溶栓组分别为 2 3(2 3/ 5 4,42 6 % )和 2 6 (2 6 / 10 0 ,2 6 0 % )节段 ,溶栓开通组存活心肌比例明显高于未溶栓组 (P <0 0 5 )。但Tc 99mMIBI活性在上述两组存活心肌中差异无显著性 (5 9 8± 11 6 ) %vs (5 6 3± 10 4) % ,P >0 0 5。结论　无论溶栓与否 ,AMI部位可能存在存活心肌 ,但成功的溶栓治疗可使梗死区更多的保持心肌存活性。Objective To identify viable myocardium in the regions of AMI by low dose dobutamine stress echocardiography (LDDSE) and quantitative rest Tc 99m MIBI tomoscintigraphy. Methods In 34 selected patients with first time Q wave AMI (thrombolysis, n=14), during the 3rd week after AMI, myocardial viability was considered if (1) there was an improvement of wall thickening (WTh)>10% during LDDSE compared with WTh <30% at rest in the same segment, and (2) Tc 99m MIBI activity was >40% in the same segment. Results One hundred seventy two segments of total 544 segments were dysfunctional and defective by qualitative SPECT. More viable myocardium existed in successfully thrombolytic group than in nonthrombolytic group (46 2% versus 26 0%, P< 0.05), but Tc 99m MIBI activity was not significantly different between these two groups [(59 8±11 6)% versus (56 3±10 4)%, P> 0 05]. Conclusions LDDSE and rest quantitative Tc 99m MIBI tomoscintigraphy provide more complete evaluation of residual myocardial viability in the AMI regions. Viable myocardium may exist regardless of thrombolysis, but thrombolysis keeps more jeopardized myocardium viable.

关 键 词：急性心肌梗死 心肌存活性 评价 超声心动图 

分 类 号：R542.22[医药卫生—心血管疾病]