硝酸甘油介入门控心肌灌注显像对急性冠状动脉综合征患者PCI治疗的疗效评价  

Evaluation of curative effect by intravenous nitroglycerin gated myocardial perfusion imaging on acute coronary syndrome patients treated by percutaneous coronary intervention

作　　者：董爱强[1] 盂祥玉 孙建梅 李现军[1] 

机构地区：[1]山东省安丘市人民医院核医学科,262100 [2]潍坊市第二人民医院急诊科,261041

出　　处：《中国实用医刊》2017年第13期83-86,共4页Chinese Journal of Practical Medicine

摘　　要：目的 应用硝酸甘油介入99Tcm-MIBI SPECT门控心肌灌注显像的方法评价经皮冠状动脉介入（PCI）治疗急性冠状动脉综合征（ACS）的疗效.方法 回顾性分析临床诊断为ACS行PCI治疗的患者40例,包括心肌梗死（冠状动脉闭塞）17例、不稳定型心绞痛（冠状动脉狭窄）23例.所有患者均于PCI术前1周内及术后1~2个月病情稳定的情况下行99Tcm-MIBI SPECT静息门控心肌灌注显像及硝酸甘油介入门控心肌灌注显像,统计左室心肌可逆性及不可逆性缺损的节段数、治疗有效率及射血分数（EF）. 结果 PCI对冠状动脉闭塞患者可逆性缺损治疗有效率为67.3%（37/55）,不可逆性缺损PCI治疗有效率为26.7%（8/30）,后者明显低于前者（χ2=12.85,P〈 0.05）.PCI治疗冠状动脉闭塞的总有效率为52.9%（45/85）,PCI治疗冠状动脉狭窄的总有效率为76.7%（69/90）,后者明显高于前者（χ2=10.84,P＆lt;0.05）.结论 硝酸甘油介入99Tcm-MIBI SPECT门控心肌灌注显像是评价ACS患者PCI术后疗效的有效手段,PCI治疗可使大部分因冠状动脉狭窄而缺血的心肌实现正常灌注、使冠状动脉梗死但存活的心肌实现再灌注,对于大多数不可逆性缺损的梗死心肌则治疗价值有限.Objective To evaluate the curative effect of percutaneous coronary intervention （PCI） on patients with acute coronary syndrome （ACS）, using intravenous nitroglycerin 99Tcm-MIBI SPECT gated myocardial perfusion imaging.Methods Forty cases of ACS including 17 cases of myocardial infarction （coronary occlusion） and 23 cases of unstable angina pectoris （coronary stenosis） were analyzed retrospectively.All patients were treated by PCI, and intravenous nitroglycerin 99Tcm-MIBI SPECT gated myocardial perfusion imaging were performed for all patients within a weeks before PCI and one to two months after PCI.The reversible and irreversible defect segment number, the effective rate of the treatment and ejection fraction （EF） were recorded to analyze.Results The treatment efficiency of PCI on coronary occlusion therapy in patients with reversible defect was 67.3%（37/55）, that in patients with irreversible defects was 26.7% （8/30）, the latter was obviously lower than the former （χ2=12.85, P〈 0.05）.The total effective rate of PCI in coronary occlusion was 52.9% （45/85）, that in coronary artery stenosis was 76.7% （69/90）, the latter was higher than the former （χ2=10.84, P〈 0.05）.Conclusions Nitroglycerin 99Tcm-MIBI SPECT gated myocardial perfusion imaging is an effective means to evaluate the efficacy of PCI in ACS patients.Schemic myocardium can gain normal perfusion by PCI treatment, and gain reperfusion for live myocardium with coronary infarction.But for the majority of irreversible myocardial infarction, the value of PCI treatment is limited.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入 心肌灌注显像 硝酸甘油 

分 类 号：R541.4[医药卫生—心血管疾病]