de Groot M R, Oostdijk A H, Engelage A H, van Marwijk Kooy M, Büller H R
Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Eur J Nucl Med. 2000 Oct;27(10):1481-6. doi: 10.1007/s002590000306.
Patients with suspected pulmonary embolism often receive heparin therapy for hours to days before ventilation/perfusion scintigraphy is completed. We assessed to what extent the lung scan classification and pulmonary vascular perfusion changed over a period of 2-4 days of full anticoagulant therapy. In 312 consecutive patients with at least one segmental perfusion defect on the initial perfusion scan, classification of both the initial and the final lung scan allowed us to study alteration in scan classification. Changes in pulmonary perfusion were assessed scintigraphically in a subgroup of 64 patients with proven pulmonary embolism. Among 79 patients with an initial high-probability lung scan, the final scan remained high probability in 77 whereas it became non-diagnostic and normal in one patient each. The lung scan classification did not change in any of the 233 patients who initially had a non-diagnostic scan. Thus, a different lung scan category was observed in only 2 out of 312 patients (0.6%; 95% CI 0.1%-2.3%). The mean pulmonary perfusion at baseline in the subgroup of 64 patients with pulmonary embolism was 62% (SD +/-17%; range 26%-89%). A mean absolute improvement in pulmonary perfusion of only 4%+/-11% (NS) was observed in the 2-4 days of observation. It is concluded that intravenous heparin therapy for a period of 2-4 days has only a minimal influence on the diagnostic lung scan classification and induces only minor changes in pulmonary vascular obstruction in the majority of patients.
疑似肺栓塞的患者在通气/灌注闪烁扫描完成前，常接受数小时至数天的肝素治疗。我们评估了在全抗凝治疗的2 - 4天期间，肺部扫描分类和肺血管灌注的变化程度。在312例初次灌注扫描至少有一个节段性灌注缺损的连续患者中，通过对初次和最终肺部扫描进行分类，我们得以研究扫描分类的变化情况。在64例经证实的肺栓塞患者亚组中，通过闪烁扫描评估肺灌注的变化。在79例初次肺部扫描为高概率的患者中，77例最终扫描仍为高概率，而另外各有1例患者的最终扫描变为非诊断性和正常。在最初扫描为非诊断性的233例患者中，肺部扫描分类均未改变。因此，在312例患者中，仅有2例（0.6%；95%CI 0.1% - 2.3%）观察到肺部扫描类别不同。64例肺栓塞患者亚组的基线平均肺灌注为62%（标准差±17%；范围26% - 89%）。在2 - 4天的观察期内，肺灌注的平均绝对改善仅为4%±11%（无统计学意义）。结论是，为期2 - 4天的静脉肝素治疗对诊断性肺部扫描分类的影响极小，且在大多数患者中仅引起肺血管阻塞的轻微变化。
