冠状动脉旁路移植术对冬眠心肌的作用  

The effects of coronary artery bypass grafting on hibernating myocardium

作　　者：吴清玉[1] 沈向东[1] 郭少先[1] 刘秀杰 李胜亭 张晓丽 李守平[3] 陈立军[3] 

机构地区：[1]中国医学科学院协和医科大学阜外心血管病医院心外科,北京100037 [2]中国医学科学院协和医科大学阜外心血管病医院核医学科,北京100037 [3]中国医学科学院协和医科大学阜外心血管病医院超声科,北京100037

出　　处：《中华心血管病杂志》2001年第8期449-452,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨冠状动脉旁路移植术 (CABG)对冬眠心肌的作用。方法　对 12 3例曾患心肌梗死者在CABG前后 ,分别作硝酸异山梨醇脂介入99mTc 甲氧基异丁基异腈 (ISDN99mTc MIBI)心肌灌注显像、小剂量多巴酚丁胺超声负荷试验 (LDDSE)和正电子发射断层氟脱氧葡萄糖 (PET18F FDG)心肌代谢显像以鉴别冬眠心肌的存在 ,并观察CABG后相应节段灌注、代谢和收缩功能的变化。结果　(1) 38例ISDN99mTc MIBI灌注显像术前后比较 ,正常灌注节段数从 15 9增至 195 ,异常灌注节段数从183减至 147,ISDN阳性组灌注计分从术前的 8.12减至术后的 3 .76 ,ISDN阴性组无明显变化。 (2 ) 6 5例LDDSE术前后比较 ,在有收缩储备的 133段中 ,CABG后运动改善的有 112段 ,无收缩储备的 191段中 ,运动改善的有 31段。 (3) 4 5例PET18F FDG代谢显像术前后比较 ,在代谢 灌注不匹配、部分匹配和匹配三组 ,节段室壁运动改善率分别为 87.5 %、5 5 .6 %和 2 8.6 %。全组无手术和住院死亡病例发生。出院后随访 5～ 40个月 ,无远期死亡。 12 3例中、91例心功能Ⅰ级 (74% ) ,32例心功能Ⅱ级(2 6 % )。结论　 (1)对心肌梗死后合并心功能不全的患者CABG能取得良好的临床效果 ;(2 )ISDN99mTc MIBI心肌灌注显像、LDDSE和PET18F FDG心肌代谢显像均能较准确?Objective The effects of CABG on hibernating myocardium were explored. Methods 123 patients with previous myocardial infarction were studied with ISDN 99m TC MIBI myocardial, low dosage Dobutamine tress echocardiography(LDDSE), and 18F FDG PET scan respectively to assess hibernating myocardium and its change in perfusion, metabolism and contraction before and after CABG. Results (1) In 38 cases referred to ISDN 99m TC MIBI myocardial imaging, normal perfusion segments increased from 159 to 195, while abnormal perfusion segments decreased from 183 to 147. (2) In 65 cases referred to LDDSE, regional wall motion improved in 12 among 133 segments with preserved contraction. While only 31 improved in 191 segments without preserved contraction. (3) In 45 cases referred to 18F FDG PET scan, percentage of motion improvement was 87.5%, 55.6% and 28.6% in the segment of metabolism perfusion mismatch, partial and match groups respectively. All patients survived and there was no later death during the follow up period of 5 40 months. 91cases(74%) were in NY HA class I and 32 cases(26%) in class II. Conclusion (1) The surgical outcome of CABG was satisfectory in the patients of cardiac dysfunction after myocardial infarction, which was demonstrated by the methods of ISDN 99m TC MIBI,LDDSE and PET 18F FDG. The function of viable ischemic myocardium improved significantly after the revascularization.(2) The segments of infarcting myocardium and hibernating myocardium can be differentiated from each other by those methods above, which may offter the important evidences for surgians to choose the way of treatment and to evaluate the prognosis of the patients after CABG.

关 键 词：冠状动脉分流术 冬眠心肌 冠状动脉旁路移植术 心肌梗死 

分 类 号：R654.2[医药卫生—外科学]