CAJ | 학술논문

目的比较直接冠状动脉(简称冠脉)内支架置入和静脉溶栓疗法在急性心肌梗死(AMI)治疗中的效果。方法 42例急诊入院AMI患者，随机分为冠脉内支架组23例，静脉溶栓组19例。两组患者均于梗塞相关动脉(IRA)再通治疗前和后行99Tcm-甲氧基异丁基异晴(MIBI)心肌SPECT显像。将左室心肌分为20个节段，并对心肌摄取99Tcm-MIBI的程度进行打分，分别计算治疗前心肌显像的总积分(SBS)、治疗后心肌显像的总积分(SAS)和两者相减的积分(SDS)。结果直接冠脉内支架组与溶栓组比较：SBS为41.3±9.8和39.4±7.9(t=1.2,P＞0.05)，SAS为17.8±6.4和27.3±6.7(t=5.8,P＜0.01),SDS为24.5±4.2和12.2±2.3(t=7.3,P＜0.01)。在冠脉内支架组的总共460个心肌节段中，IRA再通治疗前有193个3分和4分节段，治疗后有106个改善至0分(54.9%)。在溶栓组的总共380个心肌节段中，溶栓前有149个3分和4分节段，溶栓后有61个节段改善至0分(40.9%)，两组间的完全改善率差异有极显著性(P=0.014)。结论在AMI的急诊治疗中，直接冠脉内支架置入的疗效明显优于静脉溶栓疗法；99Tcm-MIBI心肌SPECT显像可对AMI患者IRA再通治疗疗效进行可靠的无创性评价。
목적비교직접관상동맥(간칭관맥)내지가치입화정맥용전요법재급성심기경사(AMI)치료중적효과。방법 42례급진입원AMI환자，수궤분위관맥내지가조23례，정맥용전조19례。량조환자균우경새상관동맥(IRA)재통치료전화후행99Tcm-갑양기이정기이청(MIBI)심기SPECT현상。장좌실심기분위20개절단，병대심기섭취99Tcm-MIBI적정도진행타분，분별계산치료전심기현상적총적분(SBS)、치료후심기현상적총적분(SAS)화량자상감적적분(SDS)。결과직접관맥내지가조여용전조비교：SBS위41.3±9.8화39.4±7.9(t=1.2,P＞0.05)，SAS위17.8±6.4화27.3±6.7(t=5.8,P＜0.01),SDS위24.5±4.2화12.2±2.3(t=7.3,P＜0.01)。재관맥내지가조적총공460개심기절단중，IRA재통치료전유193개3분화4분절단，치료후유106개개선지0분(54.9%)。재용전조적총공380개심기절단중，용전전유149개3분화4분절단，용전후유61개절단개선지0분(40.9%)，량조간적완전개선솔차이유겁현저성(P=0.014)。결론재AMI적급진치료중，직접관맥내지가치입적료효명현우우정맥용전요법；99Tcm-MIBI심기SPECT현상가대AMI환자IRA재통치료료효진행가고적무창성평개。
Objective　To evaluate and compare the theraputic effectiveness of primary coronary stenting with that of intravenous thrombolysis therapy for acute myocardial infarction (AMI) using 99Tcm-MIBI myocardial SPECT imaging. Methods　A tatal of 42 patients with AMI was undergoing primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99Tcm-MIBI myocardial SPECT imaging was performed before and 1-week after stenting or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99Tcm-MIBI uptake was expressed with a five-point scoring system. The scores of scanning before stenting or intravenous thrombolysis was described as SBS,and the scores of scanning after stenting or intravenous thrombolysis was described as SAS. Deducting SAS from SBS resulted in SDS. Results　The paired results of the stenting group vs thrombolysis group are as follows: SBS was 41.3±9.8 and 39.4±7.9 (t=1.2, P>0.05); SAS was 17.8±6.4 and 27.3±6.7 (t=5.8, P<0.01); SDS was 24.5±4.2 and 12.2±2.3 (t=7.3,P<0.01). In 193 defect segments before stenting, 106 segments (54.9%) recovered to normal after stenting. In 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) recovered to normal after thrombolysis therapy. The comparison between stenting group and thrombolysis group in improved rate of the myocardial perfusion defect scores indicated that there was a significant difference (P<0.01). Conclusions　99Tcm-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and intravenous thrombolysis in treatment of AMI. At the same time, the results indicate that primary coronary stenting seems to be more effective than intravenous thrombolysis.