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目的探讨肺通气/灌注单光子发射计算机体层摄影术(SPECT)/CT融合显像在急性肺栓塞(APE)治疗中疗效评价的应用价值。方法选择2011年4月至2015年1月临床确诊的APE患者34例,其中男性21例,女性13例;年龄38~72岁,平均年龄48.0岁。在溶栓和抗凝治疗前后均接受了肺通气/灌注SPECT显像及低剂量率同机CT显像,并在显像前/后2 d内同步行CT肺动脉造影(CTPA)检查,通过肺段表观指数法评价治疗后灌注改善效果。结果肺通气/灌注SPECT/CT融合显像受损肺段167个,受损亚肺段及更小病灶42个,其中合并慢性阻塞性肺疾病(COPD)9例,肺肿瘤2例,胸腔积液2例,肺不张、炎症2例。溶栓、抗凝治疗约2周后,APE受累肺段74.85%(125/167)恢复正常,16.17%(27/167)改善,8.98%(15/167)肺段无改善或加重;83.33%(35/42)个亚肺段恢复(28个)和改善(7个),新出现亚肺段栓塞3个。其中发病10 d内溶栓抗凝治疗效果最佳,病变恢复的比例[83.70%(113/135)]明显高于发病>10 d者[(54.05%(40/74)],差异有统计学意义(χ2=15.3,P<0.05)。结论肺通气/灌注SPECT/CT融合显像能早期评价APE病灶治疗后灌注恢复情况,并对合并的基础病变进行有效诊断,对APE进行院外治疗具有较好的筛查和指导价值。
Objective To investigate the value of lung ventilation / perfusion single photon emission computerized tomography (SPECT) / CT fusion imaging in evaluating the curative effect of acute pulmonary embolism (APE). Methods From April 2011 to January 2015, 34 patients with clinically confirmed APE were selected, including 21 males and 13 females. The average age was 48.0 years. Pulmonary ventilation / perfusion SPECT imaging and low-dose CT imaging were performed before and after thrombolysis and anticoagulation therapy. CT pulmonary angiography (CTPA) was performed before / after 2 days of imaging. Segment index method to evaluate the effect of perfusion after treatment. Results There were 167 damaged lung segments, 42 sub-lung segments and 42 smaller lesions in pulmonary ventilation / perfusion SPECT / CT fusion imaging. Among them, 9 were complicated with COPD, 2 were lung tumors, 2 cases of fluid, atelectasis, inflammation in 2 cases. After about 2 weeks of thrombolysis and anticoagulation therapy, 74.85% (125/167) of APE affected lung segments returned to normal, 16.17% (27/167) improved, 8.98% (15/167) had no improvement or aggravation of the pulmonary segment, 83.33% (35/42) sub-pulmonary segment recovery (28) and improvement (7), the new sub-pulmonary embolism 3. Among them, the thrombolysis anticoagulation therapy was the best one within 10 days after onset, the rate of pathological recovery [83.70% (113/135)] was significantly higher than that of patients with onset of more than 10 days (54.05% (40/74)], the difference was statistically significant (Χ2 = 15.3, P <0.05) .Conclusion Pulmonary ventilation / perfusion SPECT / CT fusion imaging can evaluate the early recovery of APE lesions after perfusion, and effectively diagnose the combined basic lesions. Compared with APE, Good screening and guidance value.