重症冠心病实施冠状动脉搭桥术术前应用心肌代谢显像与超声心动图的联合评估  

Application value of combination of 18F-FDG pet and ultrasound cardiogram in the assessment of patients with severe coronary heart diseases

作　　者：马义祥[1] 穆军升[1] 张健群[1] 伯平[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华医学杂志》2016年第39期3129-3132,共4页National Medical Journal of China

基　　金：北京市朝阳区科委社会发展、可持续发展与城乡一体化促进计划项目基金（SF1417）;首都医科大学学生科研创新项目（XSKY2016150）;2015年北京安贞医院院长基金（15P11）

摘　　要：目的 联合应用18F-脱氧葡萄糖（18 F-FDG） PET心肌代谢显像和超声心动图,评估其在重症冠心病患者中实施冠状动脉搭桥术中的应用价值.方法 选择北京安贞医院2015年1至11月38例住院的重症冠心病患者,男32例、女6例,年龄33 ～73（59±10）岁.所有患者均行冠状动脉造影（CAG）检查,PET心肌代谢显像和超声心动图检查,评估心肌缺血的范围、程度及梗死心肌百分率,左室射血分数（LVEF）值,左心室舒张末期内径（LVEDD）.完善检查,根据本院医生临床经验,将38例患者中实施冠脉搭桥术（CABG）分为A1组（n=20）,行保守治疗组为A2组（n=18）.结果 A1和A2组异常心肌分别为28.9％±6.3％比43.3％±4.5％（P＜0.01）,A1组明显低于A2组;梗死心肌A1组低于A2组,分别为13.0％±4.1％比24.2％±5.5％（P＜0.01）;LVEF分别为45.3％±3.8％比36.1％±6.3％（P＜0.01）,A1组高于A2组;LVEDD A1组低于A2组分别为（54.2±7.1） mm比（65.1 ±5.8） mm（P =0.003）;异常心肌所占比例和射血分数为中度负相关（r=-0.603,P =0.006）,梗死心肌所占比例和射血分数为低度负相关（r=-0.477,P=0.039）.A1组实施CABG,所有患者手术顺利,术后主动脉内球囊反搏置入1例,二次开胸止血1例,所有患者复查满意后痊愈出院,治愈率100％.A1组术前术后LVEF分别为45.3％±3.8％比51.6％±9.3％（P=0.043）,术后患者心功能得到了明显改善.A1组出院后随访1～10个月,随访率100％,仅有1例再发心绞痛,无死亡及心力衰竭等心脏事件发生.结论 心肌代谢显像联合超声心动图为重症冠心病患者实施冠脉搭桥手术的术前评估提供有力的依据,具有重大的应用价值.Objective To investigate the application value of combination of 18F-FDG PET and ultrasound cardiogram in the assessment of patients with severe coronary heart diseases.Methods A total of 38 patients with severe coronary heart diseases who were admitted to Beijing Anzhen Hospital from January 2015 to November 2015 were enrolled.There were 32 men and 6 women in this study,and the mean age was 33-73 （59 ± 10）years.All patients underwent coronary angiography,PET myocardial metabolic imaging,and echocardiography to evaluate the degree of myocardial ischemia,percentage of infarcted myocardium,left ventricular ejection fraction （LVEF）,and left ventricular end-diastolic dimension （LVEDD）.On the basis of the clinical experience of Beijing Anzhen Hospital,the study allocated these 38 patients to a CABG group （n =20）,who underwent CABG,and a non-CABG group treated by medical therapy alone （n =18）.Results A significantly smaller amount of abnormal myocardium was seen in the CABG group （28.9% ±6.3% vs 43.3% ±4.5%;P 〈 0.01）.The percentage of infarcted myocardium was significantly smaller in the CABG group （13.0% ± 4.1% vs 24.2% ± 5.5%） （P 〈 0.01）.LVEF was significantly greater （45.3% ±3.8% vs 36.1% ±6.3%,P 〈0.01） and LVEDD significantly smaller （54.2 mm ±7.1 mm vs 65.1 mm ±5.8 mm） in the CABG group （P =0.003）.Percentage of abnormal myocardium was moderately negatively correlated with LVEF （r =-0.603,P =0.006）.Percentage of infarcted myocardium was mildly negatively correlated with LVEF （r =-0.477,P =0.039）.CABG was performed without complications.The LVEF of A1 group before and after operation were 45.3% ± 3.8% vs 51.6% ± 9.3% （P =0.043）.The cardiac function of the patients was improved obviously after operation.All patients were followed for 1-10 months after discharge.The cure rate was 100%.Conclusion In patients with severe coronary heart diseases undergoing CABG,18F-FDG PET myocardial metabolic imaging combined with echocardiography have great value,

关 键 词：冠状动脉疾病 心肌灌注显像 冠状动脉旁路移植术 非体外循环 

分 类 号：R654.2[医药卫生—外科学]