放射性核素心肌灌注显像在急性冠状动脉综合征中的临床应用

近年来,急性冠状动脉综合征(ACS)在临床上越来越受到重视。应用放射性核素心肌灌注显像(MPI)可以对常规方法不能明确诊断的急性胸痛患者排除或确诊ACS作出迅速、准确判断,其诊断的灵敏度和阴性预测值均很高。MPI还有助于评价心肌缺血和梗死灶的范围和程度,对ACS患者进行危险分层,为ACS的预后判断和疗效评估提供重要信息。     

急性冠脉综合征患者血清钙浓度与急性心肌梗死的相关性

 目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙浓度的变化,探讨血清钙浓度与急性心肌梗死(acute myocardial infarction,AMI)的相关性。方法 选择2019年6-7月首都医科大学附属北京天坛医院心内科病房收治的ACS患者247例。收集患者的临床资料,采集血标本行血清钙等生化指标检测。采用二元logistic回归分析AMI的相关危险因素。结果 247例ACS患者分为两组,不稳定性心绞痛组149例,年龄(62.88±9.91)岁;AMI组98例,年龄(60.21±10.86)岁。AMI组患者的血清钙(2.21±0.11)mmol/L,明显低于不稳定性心绞痛组(2.25±0.09)mmol/L(P＜0.001)。Logistic回归分析显示,校正性别、心率、血白蛋白、总胆固醇、血磷等混杂因素后,血清钙四分位数(OR 0.591,95%CI 0.399~0.874,P=0.008)、年龄(OR 0.834, 95%CI 0.791~0.898, P＜0.001)、血红蛋白(OR 1.048, 95%CI 1.017~1.079, P=0.002)、低密度脂蛋白胆固醇(OR 2.532, 95%CI 1.544 ~4.151, P＜0.001)、GRACE评分(OR 1.129, 95%CI 1.092~1.167, P＜0.001)是AMI的独立危险因素。结论 与不稳定性心绞痛患者相比,AMI患者表现出较低的血清钙浓度,血清钙水平降低是AMI的独立危险因素。     

急性冠脉综合征患者Tei指数与冠状动脉病变复杂程度相关性研究

目的探讨急性冠脉综合征(ACS)患者Tei指数与SNYTAX积分Ⅱ(SS-Ⅱ)的相关性。方法选取北部战区总医院2018年6—12月收治的88例行冠状动脉造影检查的ACS患者为研究对象。采用三分位法将其分为低危组(0相似文献   

心肌灌注MRI和MR电影在急性冠状动脉综合征中的应用

目的　评估心肌灌注MRI和MR电影在急性冠状动脉 (简称冠脉 )综合征中的应用价值。方法　急性冠状动脉综合征患者 5 5例 ,再灌注治疗 3～ 6个月后 ,进行心脏MR影像检查。真正快速稳态梯度序列 (FIESTA)用于观察心肌运动 ;快速梯度回波序列 (FGREET)用于观察首过时相心肌灌注的MRI特征 ;反转恢复梯度回波序列 (MDE)用于观察延迟时相心肌灌注MRI特征。结果5 5例中 38例患者可见位于心内膜下心肌的首过灌注缺损 ,其信号强度相对值显著低于周围心肌。心肌灌注延迟时相MRI示 5 1例患者心室壁内存在不同范围的强化灶 ,其信号强度值是周围心肌的4 36倍 (t=1.6 9,P <0 .0 5 )。心室壁内所存在的延迟强化灶范围和信号均匀程度与心室壁运动能力显著相关 (非标准相关系数分别为 - 4 2 195、- 10 1 75 0 ,标准相关系数分别为 - 0 377、0 4 2 5 ;t分别为- 5 735、- 5 4 4 5 ,P值均 <0 .0 0 1)。结论　梗死心肌于MR心肌灌注延迟时相呈现显著强化。通过综合分析延迟强化 ,运动能力显著降低和可能存在的首过灌注缺损 ,可以更有效地识别梗死 (或瘢痕 )心肌     

Avascular necrosis of bone in severe acute respiratory syndrome

AIM: To report the incidence of avascular osteonecrosis (AVN) in severe acute respiratory syndrome (SARS) patients. MATERIALS AND METHODS: Sixty-seven SARS patients who had large joint pain between March 2003 and May 2003 underwent both plain radiographs and magnetic resonance imaging (MRI) examination on the same day. All patients received steroids and ribavirin treatment. All plain radiographs and MR images were analysed by two experienced musculoskeletal radiologists. Any abnormalities, location, extent, morphology, the number, size and signal intensity of lesions were evaluated. RESULTS: Twenty-eight patients were identified with AVN, The mean time to diagnosis of AVN was 119 days after the onset of SARS, or 116 days after steroid use. Three patients had early bilateral AVN of the femoral head, four patients of one femoral head, five patients of the bilateral hips and knees, four patients of the ipsilateral hip and knees, 10 patients of the knee(s), one patient of the right proximal fibula, and one patient of the knees and talus. Results of hip, knee and ankle plain radiographs were negative. CONCLUSION: AVN can occur in the patients with SARS. AVN had a strong association with steroid use. More studies are required to confirm whether the virus itself can also lead to AVN.     

急性冠脉综合征的急救护理

急性冠脉综合征（acutecoronarysyndrome,ACS）是一种临床急症,死亡率高,其病理基础为冠脉内的粥样斑块破裂导致血栓形成,从而引起冠状动脉的急性或亚急性堵塞。临床表现为急性心肌梗死（AMI）、不稳定型心绞痛（UA）或心源性猝死。对病人及时采取急救措施和护理,能缓解病人病情,挽救病人濒危的生命,降低病死率。我科在2005年1月一2005年9月共收治此类病人76例,经积极救治,除1例死亡外,其余75例康复出院,现将护理经验总结如下。     

潘生丁试验在冠心病心肌显像中的意义

目的：对９９ｍ Ｔｃ － Ｍ Ｉ Ｂ Ｉ心肌显像中潘生丁试验的分析,旨在评价该法在冠心病（ Ｃ Ａ Ｄ） 诊断中的意义。方法：２１ 例正常人和８８ 例 Ｃ Ａ Ｄ 患者在９９ｍ Ｔｃ － Ｍ Ｉ Ｂ Ｉ心肌显像时进行潘生丁试验。结果：潘生丁试验诊断冠心病的灵敏度为８３ ％ ,特异性为９０ ．５ ％ ,与极量运动试验相仿。结论：本法简便易行,适应证宽,值得临床推广。     

急性心肌梗死直接冠状动脉介入治疗

 目的探讨急性心肌梗死急诊介入治疗在临床应用的策略.方法76例ST段抬高和(或)新发生左束支传导阻滞的急性心肌梗死患者,男52例,女24例;年龄43～82(61.5±13.6)岁.采用经股动脉或经桡动脉途径常规方法,行急诊冠脉造影和急诊PCI.结果76例患者PCI术后梗死相关血管血流达TIMI3级73例(96.1%),TIMI血流2级1例,失败2例.74支IRA共植入支架97枚,胸痛发作至IRA再通时间≤12 h和＞12h两组在年龄和性别方面有显著差异,胸痛发作至IRA再通时间＞12 h组的冠脉多支病变和心功能不全发生率高.结论急诊PCI不仅及时开通梗死相关血管,而且能消除狭窄,减低心脏事件发生率.故有条件的医院应首选PCI为急性心梗患者的治疗措施,尤其对高龄患者、有溶栓禁忌征者及有心原性休克的患者.     

急性冠状动脉综合征粥样硬化斑块的多层螺旋CT特征

统计学意义(t=4.82,P<0.01).结论 ACS粥样硬化斑块的MSCT特征包括正性血管重构、低密度斑块、点状钙化和偏心性狭窄.     

Mimics of acute coronary syndrome on MDCT

Acute coronary syndrome (ACS) encompasses a spectrum of unstable coronary artery disease ranging from transmural myocardial infarction to unstable angina. The immediate management of these patients is dictated by the presence/absence of ST segment changes on electrocardiogram. More and more patients with non-ST elevation ACS are bypassing traditional diagnostic pathways to undergo urgent coronary catheter angiography. A proportion of these patients will have normal coronary angiography and an alternative diagnosis is often sought with multi-detector computed tomography (MDCT). It is vital that clinicians and radiologists are aware of the usual and unusual mimics of ACS so they can modify their imaging technique and protocol accordingly. In this review, we present some true mimics of ACS on MDCT, from our practice, and suggest an imaging protocol that can be utilised universally.     

急性冠状动脉综合征的现代治疗

急性冠状动脉综合征（Acrte coronary syndrome,ACS）是由于不稳定斑块的破裂,引起冠状动脉内血栓形成所致心肌缺血的一组进展性疾病谱。因为ACS发病急、病情变化快、病死率高,但可救治,所以ACS已成为当今心血管研究领域的热点之一。ACS可分为ST段持续抬高及无ST段抬高两类,前者大部分发展为ST段抬高的急性心肌梗死（ST-elevation myocardhal infarction,STEMI）,     

The influence of findings of coronary artery on myocardial salvage in acute myocardial infarction]

201Tl stress myocardial scintigraphy was performed in convalescent patients with acute myocardial infarction, to evaluate the influence of stenosis and collateral circulation of coronary artery in acute phase, on myocardial salvage in chronic phase. In 14 cases of unsuccessful coronary revascularization (complete occlusion), a complete defect of thallium imaging in chronic phase was seen in only one case of four cases with good collateral circulation, while eight of 10 cases with poor collateral circulation. In 16 cases of poor collateral circulation, six cases showed a complete defect, although the target vessel had improved to less than 75% of stenosis. However, in cases of good collateral circulation, no case showed a complete defect when the target vessel had improved to less than 75% of stenosis. The myocardial salvage is quite possible (p less than 0.05), when the coronary angiography in acute phase showed the forward flow (99% or 90% of stenosis) before coronary revascularization and/or good collateral circulation (Rentrop 2 degrees or 3 degrees).     

Scintigraphic quantification of myocardial necrosis using "hot spot" imaging agents in acute myocardial infarction]

Both technetium-99m pyrophosphate/thallium-201 dual nuclide SPECT and indium-111 antimyosin antibody/thallium-201 dual nuclide SPECT were performed in identical 11 patients with acute myocardial infarction. Infarct size was calculated by both hot spot imaging agents on dual nuclide SPECT. Antimyosin accurately accumulated in the infarcted area in all 11 patients on SPECT images corresponding with the electrocardiography, but pyrophosphate accumulated at the site of infarct in 10 of 11 patients. The mean volume obtained from pyrophosphate was 32.5 ml and that from antimyosin was 21.9 ml. The relationship between infarct volume calculated by pyrophosphate and that by antimyosin was linear and correlated well (r = 0.98, p less than 0.001). However the volume of infarction determined with pyrophosphate exceeded that with antimyosin SPECT by 1.64 (p less than 0.001). The reason for this difference is not yet known, but may relate to pyrophosphate uptake in border zones that may or may not be irreversibly injured.     

急性心肌梗死急诊介入治疗的临床观察

目的：观察急诊冠脉介入治疗(PCI)的疗效及安全性。方法：选择我科急诊收治的急性心肌梗死(心梗)患者116例进行急诊PCI，其中急性前壁、前间壁心梗68例，急性下壁心梗46例，急性前壁并下壁心梗2例；合并严重低血压或心源性休克12例，依Grenuzig’s法行PCI，必要时置入冠脉内支架。结果：本组急诊冠脉造影显示多支病变者66例，单支病变50例。73支前降支、44支右冠及8支回旋支靶血管行PCI；38例二处以上同时行PCI。成功109例，失败7例；94例患者同时植入支架117枚。1例未能通过病变。术后院内死亡4人，其中3例死于心衰、休克，1例死于室颤。随访2-93月大多数临床症状改善。结论：急性心肌梗死急诊介入治疗是一项恢复冠脉血流最直接、最有效的手段。对高危的心梗患者尤应加强围手术期的观察、处理，可降低急性心肌梗死的死亡率。     

急性冠脉综合征患者血浆肾素-血管紧张素-醛固酮系统活性测定意义

目的：通过测定急性冠脉综合征（ACS）患者血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮（Ald）水平,探讨其在ACS发生发展过程中的意义及对预后的影响。方法：采用放射免疫法分别检测22例不稳定性心绞痛（UA）、18例非ST段抬高型心肌梗死（NSTEMI）及28例ST段抬高型心肌梗死患者（STEMI）、11例健康者的血浆PRA、AngⅡ、Ald浓度,记录4周内所有患者的病情转归情况。结果：UA、NSTEMI、STEMI三组PRA、AngⅡ、Ald水平均明显高于健康对照组（P〈0.05）,组间相互比较均有统计学差异（P〈0.05）。结论：肾素-血管紧张素-醛固酮系统活性水平与ACS的发生发展有关,并且与病情的严重程度呈正相关,对预后有重要的预测价值。