摘要
目的 比较直接冠状动脉 (简称冠脉 )内支架置入和静脉溶栓疗法在急性心肌梗死(AMI)治疗中的效果。方法 42例急诊入院AMI患者 ,随机分为冠脉内支架组 2 3例 ,静脉溶栓组 19例。两组患者均于梗塞相关动脉 (IRA)再通治疗前和后行99Tcm 甲氧基异丁基异晴 (MIBI)心肌SPECT显像。将左室心肌分为 2 0个节段 ,并对心肌摄取99Tcm MIBI的程度进行打分 ,分别计算治疗前心肌显像的总积分 (SBS)、治疗后心肌显像的总积分 (SAS)和两者相减的积分 (SDS)。结果 直接冠脉内支架组与溶栓组比较 :SBS为 41 3± 9 8和 39 4± 7 9(t=1 2 ,P >0 0 5 ) ,SAS为 17 8± 6 4和 2 7 3±6 7(t=5 8,P <0 0 1) ,SDS为 2 4 5± 4 2和 12 2± 2 3(t =7 3,P <0 0 1)。在冠脉内支架组的总共46 0个心肌节段中 ,IRA再通治疗前有 193个 3分和 4分节段 ,治疗后有 10 6个改善至 0分 (5 4 9% )。在溶栓组的总共 380个心肌节段中 ,溶栓前有 149个 3分和 4分节段 ,溶栓后有 6 1个节段改善至 0分(4 0 9% ) ,两组间的完全改善率差异有极显著性 (P =0 0 14)。结论 在AMI的急诊治疗中 ,直接冠脉内支架置入的疗效明显优于静脉溶栓疗法 ;99Tcm MIBI心肌SPECT显像可对AMI患者IRA再通治疗疗效进行可靠的无创性评价。
Objective To evaluate and compare the theraputic effectiveness of primary coronary stenting with that of intravenous thrombolysis therapy for acute myocardial infarction (AMI) using 99Tcm-MIBI myocardial SPECT imaging. Methods A tatal of 42 patients with AMI was undergoing primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99Tcm-MIBI myocardial SPECT imaging was performed before and 1-week after stenting or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99Tcm-MIBI uptake was expressed with a five-point scoring system. The scores of scanning before stenting or intravenous thrombolysis was described as SBS,and the scores of scanning after stenting or intravenous thrombolysis was described as SAS. Deducting SAS from SBS resulted in SDS. Results The paired results of the stenting group vs thrombolysis group are as follows: SBS was 41.3±9.8 and 39.4±7.9 (t=1.2, P>0.05); SAS was 17.8±6.4 and 273±6.7 (t=5.8, P<0.01); SDS was 24.5±4.2 and 12.2±2.3 (t=7.3,P<0.01). In 193 defect segments before stenting, 106 segments (54.9%) recovered to normal after stenting. In 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) recovered to normal after thrombolysis therapy. The comparison between stenting group and thrombolysis group in improved rate of the myocardial perfusion defect scores indicated that there was a significant difference (P<0.01). Conclusions 99Tcm-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and intravenous thrombolysis in treatment of AMI. At the same time, the results indicate that primary coronary stenting seems to be more effective than intravenous thrombolysis.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2001年第2期71-73,共3页
Chinese Journal of Nuclear Medicine
