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冠状动脉旁路术前存活心肌的评价 附13例报告 |
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郭金成 张维君 胡旭东
王金城 米宏志 顾成雄
【摘要】 目的 对13例准备行冠状动脉旁路术(CABG)的冠心病患者术前行硝酸异山梨酯(ISDN)介入201TI心肌断层显像,评价其检测存活心肌及预测心功能恢复的价值。方法 CABG术前患者于多巴酚丁胺负荷高峰时注射201TI行负荷、 3小时再分布心肌显像后,静脉点滴ISDN并再次注射201 TI(ISDN/RI) 进行心肌显像,CABG术后3个月复查静态心肌显像,并比较术前后左室射血分数。结果 13例患者负荷像共有48个节段灌注异常,ISDN/RI显像后有29个节段灌注改善,其中26个节段在术后心肌灌注亦有改善;不可逆灌注或异常加重的19节段中,术后仍有17个节段灌注无改善,ISDN/RI显像检测存活心肌的准确性为 89.5％。且左室射血分数的提高与ISDN/RI显像可逆灌注节段数密切相关(r=0.73,P<0.005)。结论 ISDN/RI 201 TI 心肌显像在估测存活心肌和预测心功能恢复方面有较高的临床实用价值。
【关键词】 冠状动脉疾病 放射性核素显像 铊 断层摄影术
Assessment of viable myocardium before coronary artery bypass grafting (report of 13 cases) Guo Jincheng, Zhang Weijun, Hu Xudong, et al. Anzhen Hospital, Beijing 100029
【Abstract】 Objective To evaluate the clinical value of combination of 201 Tl myocardial imaging with short-term ISDN (sorbitolum) infusion in assessing ischemic but viable myocardium and predicting the improvement of abnormal left ventricular function in patients before cononary artery bypass grafting (CABG). Methods Dobutamine stress-redistribution -ISDN/reinjection 201 Tl myocardial imaging was performed on 13 patients with coronary artery disease before CABG, and resting 201 Tl imaging was repeated three months after CABG. Left ventricular ejection fraction before and after CABG was compared. Results Thirteen patients had a total of 48 segments of perfusion defects on stress imaging. Twenty nine segments were identified as reversible by ISDN/reinjection 201 Tl imaging, of which 26 segments had perfusion improvement after CABG. Among the 19 segments identified as irreversible by ISDN intervention imaging, 17 segments showed no perfusion improvement after CABG. The improvement of left ventricular ejection fraction was closely related to the number of reversible segments on ISDN/RI 201 Tl (r=0.73,P<0.005).Conclusion Short-term administration of ISDN before reinjection 201 Tl myocardial imaging is reliable, practical for detecting viable myocardium and[1] [2] 下一页
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