异舒吉^(99m)TcMIBI心肌断层显像评价直接PTCA术与溶栓治疗心肌梗死的效果  

Efficacy of Direct Angioplasty and Thrombolysis on Acute Myocardial Infarction Measured by Isosorbide Dinitrate Quantitative (99m)~Tc MIBI SPECT

作　　者：陈步星[1] 王伟民[1] 蒋宝琦[1] 徐成斌[1] 赵红[1] 王志高[2] 卢明瑜[1] 刘健[1] 高伯山[3] 岳明纲[3] 

机构地区：[1]北京医科大学人民医院心内科,北京100044 [2]北京总参北京北极寺休干所门诊部,100083 [3]北京医科大学人民医院核医学科,北京100044

出　　处：《中国医学影像学杂志》2001年第2期111-113,116,共4页Chinese Journal of Medical Imaging

摘　　要：目的 :异舒吉99mTc MIBI心肌断层显像比较直接经皮冠状动脉腔内成形术 (PTCA)与溶栓治疗急性心肌梗死的效果。材料与方法 :对 47例经直接PTCA治疗 (A组 )、溶栓再灌注成功 (B组 )和失败 (C组 )的急性心肌梗死患者行异舒吉和静态99mTc MIBI心肌显像。 2 0例经介入性治疗患者 ,术后 3个月复查静态心肌显像。结果 :不论是静态 ,还是异舒吉99mTc MIBI心肌显像 ,A组心肌缺损面积小于B组 ,B组小于C组 ,三组之间差异有显著性。与静态心肌显像比较 ,A组和B组异舒吉心肌显像提示心肌灌注明显改善 ,在C组改善不明显 ,其中A组异舒吉心肌显像灌注改善大于B组 +C组。 15例介入治疗异舒吉显像有心肌存活者 ,术后心肌缺损面积缩小 ,由术前 36 3%± 2 2 6 %降至 2 2 0 %± 19 3%。 5例无心肌存活者 ,术后心肌缺损面积与术前比较无差异。结论 :异舒吉99mTc MIBI心肌断层显像定量分析显示直接PTCA术可减少心肌缺损面积 ,挽救更多的濒死心肌 ,同时可准确识别心肌梗死后存活心肌。Purpose: To compare the efficacy of direct coronary angioplasty with thrombolysis on acute myocardial infarction (AMI) by isosorbide dinitrate quantitative 99m Tc MIBI SPECT. Materials and Methods: Forty seven AMI patients were categorized into direct PTCA (group A), intravenous thrombolysis with successful reperfusion group (group B) and non reperfusion group (group C), and underwent rest and isosorbide dinitrate quantitative technetium 99m sestamibi single photon emission computed tomography (SPECT). Rest quantitative 99m Tc MIBI SPECT on twenty patients receiving interventional therapy was repeated after three months. Results: On rest or isosorbide dinitrate images, the differences of myocardial defect size in three groups were significant (P<0.0001). The defect in group A was smaller than group B, and group B was smaller then group C. Isosorbide dinitrate significiantly improved myocardial images in group A and group B, but not in group C, with more effect in group A. Compared with prerevascularization, myocardial defect size of rest quantitative 99m Tc MIBI SPECT of postrevascularization in patients with viable myocardium was diminished from 36.3±22.6% to 22.0±19.3% (P<0.002), but that of patients without viable myocardium did not change. Conclusions: Isosorbide dinitrate quantitative 99m Tc MIBI SPECT showed that direct angioplasty after AMI can significantly diminish myocardial defect size and save more viable myocardium, and it could accurately identify viable myocardium after AMI.

关 键 词：心肌梗死 血管成形术 溶栓治疗 断层摄影术 消心痛 治疗 

分 类 号：R542.220.5[医药卫生—心血管疾病]