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目的：探讨静脉溶栓治疗对急性心肌梗死（ＡＭＩ）后心肌缺血和室壁运动障碍的影响，及９９ｍ锝甲氧基异丁基（９９ｍＴｃＭＩＢＩ）心肌显像的应用价值。方法：２３例ＡＭＩ患者，其中溶栓再灌注组１２例，无再灌注组１１例。患者在溶栓前及发病后５日～７日行９９ｍＴｃＭＩＢＩ心肌显像，发病３日～７日内行二维超声心动图检查，并随访４个月后的室壁运动状况。结果：２组患者首次心肌显像心肌缺损得分和基础室壁运动得分指数均无显著性差异（Ｐ均＞０．０５）。再灌注组第２次心肌显像心肌缺损得分（５．０±２．６）显著低于第１次得分（１６．３±３．９，Ｐ＜０．０１），缺损得分减少７０．２％±１０．８％；随访期室壁运动得分指数（１．１２±０．１６）显著低于基础指数（１．４７±０．１２，Ｐ＜０．０１）。无再灌注组２次心肌显像心肌缺损得分、随访期和基础室壁运动得分指数均无显著性差异（Ｐ均＞０．０５）。结论：早期静脉溶栓可挽救濒死心肌，缩小梗死面积，改善心功能；９９ｍＴｃＭＩＢＩ心肌灌注断层显像是判断心肌梗死范围、评价溶栓效果的较好手段。
Objective: To investigate the effect of intravenous thrombolytic therapy on myocardial ischemia and ventricular dyskinesia after acute myocardial infarction (AMI) and the clinical value of 99m TcI (99mTcMIBI) myocardial imaging. Methods: Twenty-three AMI patients, including 12 patients in the thrombolysis-reperfusion group and 11 in the non-reperfusion group. The patients underwent 99mTcMIBI myocardial imaging before thrombolysis and on the 5th to 7th after the onset of symptoms. The patients were examined by two-dimensional echocardiography within 3 days to 7 days after the onset of thrombolysis and were followed up for 4 months. Results: There was no significant difference between the first myocardial imaging score and the basement wall motion score index in the two groups (all P> 0.05). The myocardial ischemia scores of the second myocardial perfusion imaging in myocardial reperfusion group (5.0 ± 2.6) were significantly lower than those in the first time (16.3 ± 3.9, P <0.01), and the defect score decreased by 70.2 % ± 10.8%. The wall motion score index (1.12 ± 0.16) at the follow-up period was significantly lower than the basal index (1.47 ± 0.12, P <0.01). There was no significant difference in myocardial ischemia score, follow-up period and basal wall motion score index in 2 myocardial perfusion groups without reperfusion (P> 0.05). Conclusion: Early intravenous thrombolysis can save dying myocardium, reduce infarct size and improve cardiac function. 99mTcMIBI myocardial perfusion tomography is a better method to evaluate the extent of myocardial infarction and evaluate the thrombolytic effect.