硝酸甘油介入~(99m)Tc-MIBI心肌断层显像对存活心肌的评估价值

目的探讨硝酸甘油(NTG)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MI患者经皮冠状动脉介入治疗术(PCI)前行~(99)Tc-MIBl静息和NTG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;术前和术后3个月后均应用超声心动图检测心功能,两者进行对比分析。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显像显示的132个可逆性缺损节段中,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中,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);38例有存活心肌的患者PCI后其左心室射血分数较术前明显增高(P<0.01),左心室舒张末期容积和收缩末期容积均较术前有很大程度的降低(均为P<0.01);而26例无存活心肌的患者,上述指标在术前和术后差异无统计学意义(均为P>0.05)。结论 MI患者PCI前常规行NTG介入~(99m)Tc-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。

Clinical values of nitroglycerin interventing 99m Tc-MIBI SPECT imaging on patients with myocardial infarction for percutaneous coronary interventions

Objective To investigate the clinical values of nitroglycerin interventing ^99mTc-MIBI SPECT imaging on patients with myocardial infarction for percutaneous coronary interventions （PCI）. Methods ^99m Tc-MIBI SPECT imaging were performed at rest and after nitroglycerin intervening in 64 patients with myocardial infarction before PCI, and rest imaging was repeated at 3 months after PCI. Heart function of all patients were detected by echocardiograms before and at 3 months after PCI. Results A total of 232 abnormal segments were detected, including 132 reversible defect segments （56.90%） and 100 irreversible defect segments （43.10%）after nitroglycerin intervening SPECT 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 ）. Compared with those before PCI, left ventricular ejection fraction （LVEF） increased and end diastolic volume and end systolic volume decreased after PCI in 38 patients with viable myocardiums （ all P 〈 0. 01 ）, while the parameters had no changes after PCI in 26 patients without viable myocardiums （P 〉0. 05）. Conclusions Nitroglycerin intervening 99mTc-MIBI myocardial imaging play an important role in decision- making for PCI in patients with myocardial infarction.