急性心肌梗塞尿激酶溶栓治疗后影响~(99m)TC-M IBI心肌显像的多因素分析

目的　探讨影响急性心肌梗塞（ＡＭ Ｉ）溶栓再灌注后临床疗效的相关因素。方法　３９４ 例ＡＭ Ｉ患者均在尿激酶天普洛欣（ＵＫＴＰ）溶栓治疗梗塞相关血管（ＩＲＡ）再通后第７ 日采用９９ｍ ＴＣ－Ｍ ＩＢＩ心肌灌注显像（ＳＰＥＣＴ）检测心肌缺血面积（ＩＭ Ａ）。将可能影响ＩＭ Ａ 的 １０ 种因素分别进行相关分析。结果　ＩＭ Ａ 分别与发病至溶栓时间、发病年龄、溶栓前心律失常和左心衰竭、梗塞面积、ＵＫＴＰ剂量及溶栓开始至再通时间呈显著相关关系（Ｐ＜ ０．０５ 或 ０．０１）。与高血压、糖尿病、高脂血症无相关关系（Ｐ 均＞ ０．０５）。结论　溶栓治疗ＡＭ ＩＩＲＡ 再通后 ＩＭ Ａ 受多种因素影响，采取针对性控制措施对提高ＡＭ Ｉ的临床疗效有重要价值。

RELATIONSHIP BETWEEN MULTIFACTOR AND EFFECT OF THROMBOLYTIC THERAPY WITH UROKINASE ON ACUTE MYOCARDIAL INFARCTION BY 99m Tc MIBI MYOCARDIAL IMAGING

Objective To investigate the relative factors affecting the therapeutic effects of thrombolytic therapy on acute myocardial infartion(AMI).Method The ischemic myocardium area (IMA) of 394 patients with AMI were quantitatively analysed by 99m Tc methoxy isobutyl isontrile (MIBI) myocardial perfusion SPECT,at seventh day after infarct related coronary artery (IRA)being reperfused by thrombolytic therapy with urokinase techpool(UKTP).Relationship between IMA and ten factors was respectively analysed.Result There were significantly relationship between IMA and the time from onset to starting thrombolysis,age,arrhythmias and heart failure before thrombolytiv,infarct area,dose of UKTP,the time from starting thrombolysis to reperfusion (P<0.05or 0.01).No relationship between IMA and hypertension,diabetes,hyperlipemia (P>0.05).Conclusion IMA measured quantitatively by 99m Tc MIBI myocardial imaging SPECT can evaluate the therapeutic effect of thrombolytic therapy with UKTP for AMI.IMA is also affected by relative multifactor.The approaches to control affecting factors may help increasing the therapeutic effect of thrombolytic therapy for AMI.