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[急性心肌梗死心脏功能评估及治疗效果——急性期与慢性期放射性核素方法对比]

[The evaluation of cardiac function and the effect of therapy in acute myocardial infarction--comparison by radio nuclide method in acute and chronic phase].

作者信息

Morishita T, Yamazaki J, Kawamura Y, Iida M, Okuzumi I, Muto T, Wakakura M, Saito T, Kamijima G, Sasaki Y

机构信息

First Department of Internal Medicine, Toho University of Medicine, Tokyo, Japan.

出版信息

Radioisotopes. 1987 Sep;36(9):445-51. doi: 10.3769/radioisotopes.36.9_445.

Abstract

The cardiac function and the effect of therapy in patients with acute myocardial infarction (AMI) were assessed in over 100 patients by analysis of 201Tl-scintigraphy and 99mTc-gated pool study in our ICU. The cardiac function and 201Tl-defect ratio were compared with the results obtained in chronic phase. Sixteen of them were treated with intravenous urokinase (UK) within 6 hours from onset. The other 18 patients without UK treatment served as a control group. Significant correlation was recognized between 201Tl-defect ratio and peak-CPK levels, peak-GOT levels, peak-LDH levels. Significant correlation (r = -0.655, r = -0.713) were found between 201Tl-defect ratio and LVEF in acute and chronic phase. The UK group showed a significant increase of LVEF as compared with the control group in patients with antero-septal (A/S) AMI. In inferior (INF) AMI, no significant differences were observed UK and control group in LVEF, RVEF and 201Tl-defect ratio. In chronic phase, improvements of LVEF and 201Tl-defect ratio were observed in patients with A/S AMI. But no significant differences of LVEF, RVEF and 201Tl-defect ratio were observed in A/S AMI in acute and chronic phase. The UK group showed a significant increase of LVEF (50.1%) as compared with the control group of A/S AMI in chronic phase. We have demonstrated that a combination of 201Tl-scintigraphy and 99mTc-gated pool study are useful techniques in ICU, to evaluate the cardiac function and the effect of thrombolysis therapy and thus greatly contribute to the primary care of AMI cases.

摘要

在我们的重症监护病房(ICU),通过对100多名急性心肌梗死(AMI)患者进行铊-201(²⁰¹Tl)心肌显像和锝-99m(⁹⁹ᵐTc)门控心血池显像分析,评估了其心脏功能及治疗效果。将心脏功能和²⁰¹Tl缺损率与慢性期的结果进行了比较。其中16例患者在发病后6小时内接受了静脉注射尿激酶(UK)治疗。另外18例未接受UK治疗的患者作为对照组。²⁰¹Tl缺损率与肌酸磷酸激酶(CPK)峰值水平、谷草转氨酶(GOT)峰值水平、乳酸脱氢酶(LDH)峰值水平之间存在显著相关性。在急性期和慢性期,²⁰¹Tl缺损率与左心室射血分数(LVEF)之间均存在显著相关性(r = -0.655,r = -0.713)。在前间壁(A/S)AMI患者中,UK组的LVEF较对照组显著升高。在下壁(INF)AMI患者中,UK组和对照组在LVEF、右心室射血分数(RVEF)和²⁰¹Tl缺损率方面未观察到显著差异。在慢性期,A/S AMI患者的LVEF和²⁰¹Tl缺损率有所改善。但在A/S AMI的急性期和慢性期,LVEF、RVEF和²⁰¹Tl缺损率未观察到显著差异。在慢性期,A/S AMI的UK组LVEF较对照组显著升高(50.1%)。我们已经证明,²⁰¹Tl心肌显像和⁹⁹ᵐTc门控心血池显像相结合是ICU中评估心脏功能和溶栓治疗效果的有用技术,从而极大地有助于AMI病例的初级护理。

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