硝酸甘油介入心肌断层显像对存活心肌的判断价值

目的探讨硝酸甘油介入心肌断层显像对心肌梗死（MI）患者存活心肌的判断价值。方法64例心肌梗死患者经皮冠状动脉介入治疗术（PCI）前行^99mTc-MIBI静息和硝酸甘油（NTG）介入心肌显像，术后3个月时复查静息心肌显像，并进行对比分析。结果64例患者静息显像共有232个节段（40．28％）心肌核素摄取异常，NTG介入心肌显像后有132个节段（56．90％）呈可逆性缺损，100个节段（43．10％）呈不可逆性缺损；PCI术后136个心肌节段（58．62％）心肌灌注得到改善，术前NTG介入显像显示的132个可逆性缺损节段，术后120个节段（90．91％）心肌灌注改善，术前NTG介入显像显示的100个不可逆性缺损节段，术后16个节段（16．0％）心肌灌注改善，二者比较差异有统计学意义（P〈0．05）；而26例无存活心肌的一组患者，上述指标在术前和术后差异无统计学意义（P〉0．05）。结论MI患者PCI前常规行NTG介入^99mTc-MIBI心肌显像对是否进行PCI治疗的病例选择有决策性指导作用。

The clinical values of 99mTc-MIBI SPECT imaging after nitroglycerin administration on viable myocardium in patients with myocardial infarction

Objective To investigate the clinical values of 99mTc-MIBI SPECT imaging after nitroglyc-erin administration on decision-making of patients with myocardial infarction for pecutaneous coronary interven-tions. Methods 64 patients with myocardial infarction were performed with 99mTc-MIBI SPECT rest imaging and nitroglycerin intervening imaging before PCI, rest imaging was repeated at 3 months after PCI, images of which were compared and analyzed. Heart function of all patients were detected by echocardiograms before PCI and at 3 months after PCI, data of which were compared and analyzed. Results 232 abnormal segments were detected in 64 patients, which included 132reversible defect segments(56. 90%)and 100 irreversible defect seg-ments(43.10%) after nitroglycerin intervening imaging. Of 232 abnormal segments after PCI, 136 segments (58.62%) showed improved perfusion. Of 132 reversible defect segments before PCI, 120 segments(90.91%) showed improved perfusion. Of 100 irreversible defect segments before PCI, only 16 segments (16.0%) showed improved perfusion(P < 0.05). There was no difference among these data in 26 patients without viable myocar-diums(P >0.05). Conclusion The results of NTG intervening 99mTc-MIBI myocardial imaging play a signifi-cant decision-making role on the selection of patients with myocardial infarction for PCI.