论文部分内容阅读
目的 评价2 0 1 TlSPECT心肌显像在激光心肌再血管化 (TMLR)治疗缺血性心脏病中的价值。方法 19例心肌梗死病人均行TMLR治疗 ,经左第 5肋间 ,前外侧切口 ,显露心脏 ,使用高能量 (80 0W)CO2 心脏激光治疗仪于心脏跳动中作心肌打孔 ,经食管超声监测打孔情况 ,打孔部位在左心室游离壁 ,平均打孔前壁 (8 3± 2 9)个 ,侧壁 (6 9± 2 5 )个 ,下壁 (5 4± 2 0 )个 ,心尖 (5 3± 4 4)个。在TMLR治疗前 ,均行潘生丁负荷试验 (ST) “再分布”(RD) 硝酸甘油 (NTG)介入 +再注射 (NTG +RI) 2 0 1 TlSPECT心肌显像。潘生丁剂量按体重 0 7mg kg ,4min内慢速静脉推注 ,注射完 2min后 ,静脉注射2 0 1 Tl 111MBq ,10min后行SPECT心肌显像 ,“再分布”显像于 3～ 4h后进行。继而舌下含服硝酸甘油 0 6mg ,静脉再注射2 0 1 Tl37MBq,10min后行第 3次SPECT显像。TMLR治疗后随访 3个月显像17例 ,6个月显像 11例 ,1a显像 5例。结果 19例病人共有 5 6个心肌灌注异常节段 ,随机选取 45个节段行TMLR治疗。其中术后 18个节段心肌血流灌注有改善 ,治疗有效率为 40 %。术前RD NTG+RI2 0 1 TlSPECT心肌显像有显著再分布的 18个节段 ,术后 77 8% (14个 )节段心肌灌注改善。术前2 0 1 TlSPECTRD心肌显像图上有显著再分布的
Objective To evaluate the value of T 0 SPECT myocardial imaging in the treatment of ischemic heart disease by laser myocardial revascularization (TMLR). Methods Nineteen patients with myocardial infarction were treated with TMLR. The left intercostal space and the anterolateral incision were made and the heart was exposed. High-energy (80 W) CO2 laser was used to perfuse the heart during cardiac beating. In the perforation site, the perforated area was in the left ventricular free wall with an average of 83 3 29 anterior perforated walls, 6 9 2 5 lateral walls and 54 4 0 2 inferior walls, (5 3 ± 4 4). Before the TMLR treatment, the dipyridamole load test (ST) redistribution (RD) NTG interventional + reperfusion (NTG + RI) 210 TlSPECT myocardial imaging were performed. Dipyridamole dose according to body weight 0 7mg kg, 4min slow intravenous injection, 2min after injection, intravenous injection of 210LI 111MBq, 10min after SPECT myocardial imaging, “redistribution” imaging in 3 ~ 4h after. Then sublingual nitroglycerin 0 6mg, intravenous injection of 210 Tl37MBq, 10min after the third SPECT imaging. TMLR treatment followed up for 3 months in 17 cases, 6 months imaging in 11 cases, 1a imaging in 5 cases. Results Sixteen patients had a total of 56 myocardial perfusion abnormalities, and 45 segments were randomly selected for TMLR treatment. Postoperative 18 segments of myocardial perfusion improved, the treatment efficiency was 40%. Preoperative RD NTG + RI2 0 1 TlSPECT myocardial imaging showed a significant redistribution of 18 segments, postoperative 77 8% (14 segments) myocardial perfusion improved. Preoperative 2101 TlSPECTRD myocardial imaging showed significant redistribution