【摘要】 目的 对13例准备行冠状动脉旁路术(CABG)的冠心病患者术前行硝酸异山梨酯(ISDN)介入²⁰¹ TI心肌断层显像,评价其检测存活心肌及预测心功能恢复的价值。方法 CABG术前患者于多巴酚丁胺负荷高峰时注射²⁰¹ TI行负荷、3小时再分布心肌显像后,静脉点滴ISDN并再次注射²⁰¹ TI(ISDN/RI)进行心肌显像,CABG术后3个月复查静态心肌显像,并比较术前后左室射血分数。结果 13例患者负荷像共有48个节段灌注异常,ISDN/RI显像后有29个节段灌注改善,其中26个节段在术后心肌灌注亦有改善;不可逆灌注或异常加重的19节段中,术后仍有17个节段灌注无改善,ISDN/RI显像检测存活心肌的准确性为89.5%。且左室射血分数的提高与ISDN/RI显像可逆灌注节段数密切相关(r=0.73,P<0.005)。结论 ISDN/RI ²⁰¹ TI心肌显像在估测存活心肌和预测心功能恢复方面有较高的临床实用价值。

    Assessment of viable myocardium before coronary artery bypassgrafting (report of 13 cases) Guo Jincheng, ZhangWeijun, Hu Xudong, et al. Anzhen Hospital, Beijing 100029

     【Abstract 】 Objective To evaluate theclinical value of combination of ²⁰¹ Tlmyocardial imaging with short-term ISDN (sorbitolum) infusion in assessing ischemic butviable myocardium and predicting the improvement of abnormal left ventricular function inpatients before cononary artery bypass grafting (CABG). Methods Dobutamine stress-redistribution -ISDN/reinjection ²⁰¹ Tl myocardial imaging was performed on 13 patients with coronaryartery disease before CABG, and resting ²⁰¹ Tl imaging was repeated three months after CABG. Left ventricularejection fraction before and after CABG was compared. Results Thirteen patients had a total of 48 segments of perfusion defectson stress imaging. Twenty nine segments were identified as reversible by ISDN/reinjection ²⁰¹ Tl imaging, of which 26 segments had perfusion improvement afterCABG. Among the 19 segments identified as irreversible by ISDN intervention imaging, 17segments showed no perfusion improvement after CABG. The improvement of left ventricularejection fraction was closely related to the number of reversible segments on ISDN/RI ²⁰¹ Tl (r=0.73,P<0.005).Conclusion Short-term administration of ISDN before reinjection ²⁰¹ Tl myocardial imaging is reliable, practical for detecting viablemyocardium and predicting improvemnet of cardiac function.

     【Key words 】 coronary artery disease radionuclideimaging thallium tomography

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