AMI患者直接与择期PTCA术后心肌活性及左室功能的研究  

Evaluation of the efficacy of primary angioplasty and selective angioplasty for myocardial viability and cardiac function in patients with acute myocardial infarction using 18F-FDG SPECT and 99Tcm-MIBI gated SPECT

作　　者：张建[1] 王铁[2] 崔亮[3] 王乐丰[3] 武秀朵[2] 刘枢[2] 曲士颖[2] 黄京伟[2] 

机构地区：[1]首都医科大学附属北京朝阳医院综合科,100020 [2]首都医科大学附属北京朝阳医院核医学科,100020 [3]首都医科大学附属北京朝阳医院心脏中心,100020

出　　处：《中华核医学杂志》2002年第6期335-337,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的　比较直接与择期经皮冠状动脉腔内成形术 (PTCA)对急性心肌梗死 (AMI)后患者心肌活性及左室功能的影响。方法　采用双探头符合线路SPECT ,分别对 2 4例经直接PTCA治疗 (直接PTCA组 )和 2 2例经择期PTCA治疗 (择期PTCA组 )的AMI患者于PTCA术后 10～ 2 0d进行99Tcm 甲氧基异丁基异腈 (MIBI)门控心肌断层显像 ,并在 1周内完成心肌1 8F 脱氧葡萄糖 (FDG)符合线路显像。将MIBI摄取明显减低或无摄取而FDG摄取明显改善的心肌节段判定为存活心肌。结果　直接PTCA组与择期PTCA组的心肌灌注减低节段分别为 16 .2 % (35 2 16个 )和 2 8.3% (5 6 198个 ) ,2组比较差异有显著性 (χ2 =8.8,P <0 .0 1) ;存活心肌节段分别为 77.1% (2 7 35个 )和 5 3.6 % (30 5 6个 ) ,2组比较差异有极显著性 (χ2 =18.4 ,P <0 .0 0 1) ;左室射血分数 (LVEF)分别为 (6 5 .4± 9.8) %和 (5 1.2±10 .3) % ,2组比较差异有显著性 (t=2 .5 ,P <0 .0 5 )。结论　直接PTCA能更有效地增加心肌血流灌注 ,并可更多地挽救AMI患者的存活心肌和保护心脏功能。ObjectiveTo compare the efficacy of primary angioplasty with selective angioplasty in the treatment of acute myocardial infarction (AMI), particularly for myocardial viability and cardiac function. MethodsA total of 46 patients with AMI underwent either primary angioplasty (primary PTCA group, 24 patients) or selective angioplasty (selective PTCA group, 22 patients). Myocardial viability and cardiac function (left ventricular ejection fraction, LVEF) were assessed during hospitalization by 18F-FDG imaging and 99Tcm-MIBI gated myocardial tomography imaging with a dual-head coincidence gamma camera for all patients. The criterion of viable myocardial segment was defined as a segment with improved FDG uptake coexisting with abnormal MIBI perfusion (hypoperfusion). THResultsThe percentages myocardial segments of hypoperfusion and improved FDG uptake in primary PTCA group were 16.2%(35/216) and 77.1%(27/35), while in selective PTCA group were 28.3%(56/198) and 53.6%(30/56). There was significant difference between two groups (P<0.01). There was significant difference between primary PTCA group and selective PTCA group in LVEF [(65.4±9.8)% vs (51.2±10.3)%, P<0.05]. ConclusionThe presented study shows that primary PTCA is more effective than selective PTCA in retrieving viable myocardium and preserving cardiac function after AMI.

关 键 词：AMI PTCA 术后 心肌活性 左室功能 MIBI 脱氧葡萄糖 急性心肌梗死 经皮冠状动脉腔内成形术 SPECT 

分 类 号：R542.22[医药卫生—心血管疾病]