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目的:研究核素心肌显像在识别存活心肌中的准确性及实用性。方法 :对 2 0 0 0年 10月～ 2 0 0 1年 9月行 PTCA+支架术的 30例住院心肌梗死患者 (梗塞后 2周至 3个月 ) ,采用 PTCA支架术前静点小剂量多巴酚丁胺 (3μg· kg- 1· min- 1 ) ,并合用舌下含服硝酸甘油 (0 .5 m g) 99m TC- MIBI心肌显像 ,与术后 3周时复查静息 99m TC-MIBI心肌显像进行对比 ,观察多巴酚丁胺与硝酸酯合用预测存活心肌的准确度及安全性。结果:PTCA支架术前静息 99m Tc- MIBI心肌灌注显像共有 117个节段心肌摄取异常。药物介入 99m Tc- MIBI心肌灌注显像及 PTCA支架术后 3周静息 99m Tc- MIBI心肌灌注显像放射性分布异常节段心肌血流灌注改善。术前静息心肌灌注显像的 117个节段 ,药物介入 99m Tc- MIBI心肌灌注显像有 4 1个节段灌注改善 ,2 3个节段正常 ,5 3个节段无变化。PTCA支架术后 3周随访中有 4 8个节段改善 ,2 8个节段正常 ,无效的 5 3个节段在 PTCA支架术后有 4 1个节段心肌灌注无改善。结论 :以 PTCA支架术后 3周为标准 ,静脉应用小剂量多巴酚丁胺时舌下含服硝酸甘油 (0 .5 m g)核素心肌显像 ,预测存活心肌灵敏度为 84 .2 % ,特异度为 77.4 % ,具有安全性高、副作用小、患者易于接受的优点
Objective: To study the accuracy and practicability of radionuclide myocardial imaging in identifying viable myocardium. Methods: Thirty patients with in-hospital myocardial infarction (2 weeks to 3 months after infarction) underwent PTCA + stenting from October 2000 to September 2001 were enrolled in this study. The low dose dopa (3μg · kg-1 · min-1) and combined sublingual nitroglycerin (0.5 mg) 99m TC-MIBI myocardial imaging, and after 3 weeks of rest resting 99m TC-MIBI Myocardial imaging were compared to observe the combination of dobutamine and nitrate to predict the accuracy and safety of viable myocardium. Results: A total of 117 segments of myocardial infarction in 99m Tc-MIBI myocardial perfusion imaging before PTCA stent implantation were abnormal. 99m Tc-MIBI Myocardial Perfusion Imaging After Drug Intervention and Resting 99m Tc-MIBI Myocardial Perfusion Imaging 3-Weeks After PTCA Stent Myocardial Perfusion Changes with Abnormal Distribution of Radioactivity Abnormalities. Preoperative myocardial perfusion imaging of the 117 segments, drug intervention 99m Tc-MIBI myocardial perfusion imaging improved perfusion 41 segments, 23 segments normal, 53 segments without change. In the 3-week follow-up of PTCA stents, 48 segments improved, 28 segments were normal, and 53 segments failed to improve myocardial perfusion in 41 segments after PTCA. CONCLUSIONS: With 3-week postoperative PTCA as a standard, myocardial perfusion of nitroglycerin (0.5 mg) was performed intravenously with low-dose dobutamine, and the sensitivity of surviving myocardium was 84.2% The specificity of 77.4%, with high safety, side effects, the advantages of patients with easy to accept