^(201)Tl SPECT心肌显像在激光心肌再血管化治疗中的应用  

The role of ^(201)Tl SPECT in detecting myocardial viability in patients undergoing transmyocardial laser revascularization

作　　者：王金城[1] 王蒨[1] 屈正[2] 米宏志[1] 于建波[2] 杨浩[1] 陆遥[1] 丁健[1] 

机构地区：[1]首都医科大学附属北京安贞医院核医学科,100029 [2]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华核医学杂志》2000年第4期148-150,共3页Chinese Journal of Nuclear Medicine

基　　金：北京市科委科技基金!资助项目 (952 60 0 90 0 )

摘　　要：目的　评价2 0 1 TlSPECT心肌显像在激光心肌再血管化 (TMLR)治疗缺血性心脏病中的价值。方法　 19例心肌梗死病人均行TMLR治疗 ,经左第 5肋间 ,前外侧切口 ,显露心脏 ,使用高能量 (80 0W)CO2 心脏激光治疗仪于心脏跳动中作心肌打孔 ,经食管超声监测打孔情况 ,打孔部位在左心室游离壁 ,平均打孔前壁 (8 3± 2 9)个 ,侧壁 (6 9± 2 5 )个 ,下壁 (5 4± 2 0 )个 ,心尖 (5 3± 4 4)个。在TMLR治疗前 ,均行潘生丁负荷试验 (ST) “再分布”(RD) 硝酸甘油 (NTG)介入 +再注射 (NTG +RI) 2 0 1 TlSPECT心肌显像。潘生丁剂量按体重 0 7mg kg ,4min内慢速静脉推注 ,注射完 2min后 ,静脉注射2 0 1 Tl 111MBq ,10min后行SPECT心肌显像 ,“再分布”显像于 3～ 4h后进行。继而舌下含服硝酸甘油 0 6mg ,静脉再注射2 0 1 Tl37MBq,10min后行第 3次SPECT显像。TMLR治疗后随访 3个月显像17例 ,6个月显像 11例 ,1a显像 5例。结果　 19例病人共有 5 6个心肌灌注异常节段 ,随机选取 45个节段行TMLR治疗。其中术后 18个节段心肌血流灌注有改善 ,治疗有效率为 40 %。术前RD NTG+RI2 0 1 TlSPECT心肌显像有显著再分布的 18个节段 ,术后 77 8% (14个 )节段心肌灌注改善。术前2 0 1Objective To evaluate the value of detecting viable myocardium by 201 Tl SPECT myocardial imaging in transmyocardial laser revascularization (TMLR) Methods 19 patients with prior myocardial infarction and unstable angina confirmed by coronary angiography underwent TMLR Before TMLR, dipyridamol stress test (ST) “redistribution' (RD) nitroglycerin (NTG) infusion reinjecting (NTG+RI) 201 Tl SPECT myocardial imaging were performed on all 19 patients Of 56 segments of left ventricle with myocardial ischemia or infarction found by 201 Tl SPECT imaging,45 segments (physicians' decision) underwent TMLR using a high energy (800 W) CO 2 laser TMLR was performed on the free walls of the left ventricle of the beating heart The average numbers of transmyocardial channels on various segments were: 8 3±2 9 on anteral wall, 6 5±2 5 on lateral wall, 5 4±2 0 on inferal wall, 5 3±4 4 on apex 3, 6 to 12 months after TMLR, ST RD NTG+RI 201 Tl SPECT imaging was repeated in 19 patients, and then followed up for 3 months in 17 cases, 6 months in 11 cases, 1 year in 5 cases Results Of 45 segments which had TMLR, 18 segments (40%) showed improved perfusion of myocardium Of 18 segments showed marked redistribution before TMLR, 14 segments (77 8%) were improved in myocardial perfusion after TMLR All of 8 segments showed marked redistribution in RD imaging before TMLR showed improved myocardial perfusion after TMLR Among 27 segments without redistribution in RD NTG+RI 201 Tl myocardial imaging, only 4 segments (14 8%) showed improved perfusion after TMLR Conclusions Stress test redistribution NTG infusion+reinjection 201 Tl myocardial imaging is a valuable procedure to select patients for TMLR and to evaluate results of TMLR therapy

关 键 词：心肌梗死 铊201 SPECT 心肌显像 TMLR 

分 类 号：R817.4[医药卫生—影像医学与核医学]