Hélias J, Daumy F, Nicolas F, Nicolas G
Arch Mal Coeur Vaiss. 1986 Jan;79(1):69-74.
Traumatic myocardial contusion is observed in 15% of autopsy studies; however, it is much more difficult to detect in survivors. Thirty-two consecutive, unselected patients admitted to the intensive care unit for serious thoracic injuries, underwent Th 201 myocardial scintigraphy in 2 to 4 different projections, 2 to 13 days after admission. The results were interpreted double blind and considered positive when a zone of hypofixation creating a defect greater than 25% was observed. The results were correlated with daily ECG recordings, serum CPK MB levels and echocardiography. Thirteen patients (41%) had abnormal scintigraphy. Border line appearances in 1 case excluded any severe myocardial lesions. The other investigations (56%) were normal. These results did not correlate with the ECG or echocardiographic appearances but a significant relationship was found with serum CPK MB levels (p less than 0.05). Therefore, the first investigations did detect cardiac damage but were not specific for myocardial lesions. Thallium 201 myocardial scintigraphy is superior to other non-invasive investigations. It provides information as to the size of the lesion and, by repeated studies, can differentiate simple myocardial contusion from a true traumatic myocardial infarction.
尸检研究显示，15%的病例存在创伤性心肌挫伤；然而，在幸存者中更难检测到。连续32例因严重胸部损伤入住重症监护病房的非选择性患者，在入院后2至4天接受了201铊心肌闪烁显像，显像采用2至4个不同的投照角度。结果采用双盲法解读，当观察到固定减低区形成大于25%的缺损时，结果被视为阳性。结果与每日心电图记录、血清肌酸磷酸激酶同工酶（CPK MB）水平及超声心动图结果进行了相关性分析。13例患者（41%）闪烁显像异常。1例临界表现排除了任何严重心肌病变。其他检查（56%）结果正常。这些结果与心电图或超声心动图表现不相关，但与血清CPK MB水平存在显著相关性（p<0.05）。因此，最初的检查确实检测到了心脏损伤，但对心肌病变不具有特异性。201铊心肌闪烁显像优于其他非侵入性检查。它能提供有关病变大小的信息，并且通过重复检查，可以区分单纯心肌挫伤和真正的创伤性心肌梗死。
