D-SPECT评价体外心脏震波治疗对PCI术后患者血流灌注及心功能的影响

目的 评价新型心脏专用机D-SPECT在体外心脏震波治疗经皮冠状动脉介入术( percutaneous coronary intervention, PCI)患者前后血流灌注及心功能的影响.方法 在同济大学附属第十人民医院行PCI术后接受体外心脏震波治疗的患者30例,男22例,女8例,分别在 PCI术后3个月行体外心脏震波治疗( cardiac shock wave therapy, CSWT)前接受D-SPECT一日法腺苷负荷心肌灌注检查,CSWT治疗后6～9个月再次接受D-SPECT一日法腺苷负荷心肌灌注检查,使用定量灌注 SPECT ( quantitative perfusion SPECT, QPS )和定量门控 SPECT (quantitative gated SPECT, QGS)图像处理软件,分析比较心肌17节段分布下体外心脏震波治疗前后静息/负荷状态下左心室射血分数(left ventricular enjection fraction, LVEF)%、总负荷评分(sunned stress score, SSS)、总静息评分(summed rest score, SRS)、静息/负荷舒张末容积(end diastolic volume, EDV)、静息/负荷收缩末容积( end systolic volume, ESV)以及了解治疗前后静息/负荷状态下心肌缺损程度总评分、心肌缺损节段数的变化情况及典型图片分析.结果 静息及负荷状态下心肌缺血节段数治疗后较治疗前均明显减少(P＜0. 05);静息和负荷状态下心肌各节段灌注总评分治疗后较治疗前明显减低(P＜0. 05);心功能检测指标: 静息/负荷状态下LVEF(%)治疗后较治疗前提高(P＜0. 05);静息/负荷状态下EDV、ESV较治疗后明显改善( P＜0. 05);典型图片提示治疗后心肌缺血面积明显缩小.结论 D-SPECT心肌核素灌注显像可以很好的评价心肌血流灌注及心功能的情况,临床应用前景广阔.体外心脏震波对PCI术后患者心肌功能的恢复有明显的改善作用,是一项无创、安全、有效的辅助治疗手段.

Efficacy of cardiac shock wave therapy on blood perfusion and cardiac function in patients following PCI evaluated by D-SPECT

Objective To evaluate the efficacy of cardiac shock wave therapy(CSWT) on cardiac perfusion and cardiac function in patients following percutaneous coronary intervention(PCI) by dynamic single-photon emission computed tomography(D-SPECT). Methods Thirty patients(22 males and 8 females) who underwent CSWT after PCI received adenosine overload D-SPECT myocardial perfusion examination before and 6-9 months after CSWT. QPS-QGS image processing software was used for analysis. The LVEF%, SSS, SRS, EDV, ESV, total score of myocardial defect, number of segments of myocardial defect were analyzed and compared before and after CSWT. Results The number of myocardial ischemic segments in resting and overloading state decreased significantly after treatment(P<0.05); the total score of myocardial perfusion in resting and overloading state decreased significantly after treatment(P<0.05). The cardiac function test indexes EF(%) in resting/overloading state increased significantly after treatment(P<0.05); EDV and ESV in resting/loading state improved significantly after treatment(P<0.05). Conclusion CSWT is a noninvasive, safe and effective adjuvant therapy for the recovery of myocardial function in patients following PCI; and D-SPECT myocardial radionuclide perfusion imaging can be used to evaluate the efficacy of CSWT.