CAJ | 학술논문

目的探讨核素心肌灌注显像(myocardiac perfusion imaging,MPI)在合并心血管疾病拟行关节置换患者中评估围手术期冠脉缺血的临床应用价值,对比分析MPI和冠脉CT造影(computed tomography angiogram,CTA)对冠脉评估一致性及对手术计划的影响.方法前瞻性收集合并心血管疾病拟行关节置换的患者病例资料,行MPI及CTA检查,根据MPI评估心肌血流灌注情况决定是否手术,统计分析MPI及CTA对冠脉评估的一致性和对手术计划的影响,并记录术后心血管并发症情况.结果共纳入228例患者,男97例,女131例;年龄53 ～ 88岁,平均73.2岁.MPI未发现心肌缺血215例,发现不同程度心肌缺血13例.无心肌缺血患者CTA检查显示:113例无冠脉狭窄,51例轻度冠脉狭窄,39例中度冠脉狭窄,12例重度冠脉狭窄.心肌缺血患者CTA检查显示3例无冠脉狭窄,4例轻度冠脉狭窄,3例中度冠状动脉狭窄,3例重度冠脉狭窄,MPI和CTA检查对冠脉评估的一致性较差.222例患者按计划实施手术,6例患者取消手术,MPI检查结果对手术计划有明显影响,而CTA检查结果对手术计划无明显影响.术后无心肌缺血相关的心绞痛、心肌梗塞及心源性死亡病例,心血管并发症包括6例心衰,4例房颤及1例脑梗塞.结论 MPI是冠脉缺血评价的直接指标,能够准确预测围手术期冠脉缺血风险及预后,可筛选出需要延迟或禁忌手术的病例,对于临床手术计划的取舍具有重要参考意义,有助于降低并发症、提高围手术期安全性.
목적 탐토핵소심기관주현상(myocardiac perfusion imaging,MPI)재합병심혈관질병의행관절치환환자중평고위수술기관맥결혈적림상응용개치,대비분석MPI화관맥CT조영(computed tomography angiogram,CTA)대관맥평고일치성급대수술계화적영향.방법 전첨성수집합병심혈관질병의행관절치환적환자병례자료,행MPI급CTA검사,근거MPI평고심기혈류관주정황결정시부수술,통계분석MPI급CTA대관맥평고적일치성화대수술계화적영향,병기록술후심혈관병발증정황.결과 공납입228례환자,남97례,녀131례;년령53 ～ 88세,평균73.2세.MPI미발현심기결혈215례,발현불동정도심기결혈13례.무심기결혈환자CTA검사현시:113례무관맥협착,51례경도관맥협착,39례중도관맥협착,12례중도관맥협착.심기결혈환자CTA검사현시3례무관맥협착,4례경도관맥협착,3례중도관상동맥협착,3례중도관맥협착,MPI화CTA검사대관맥평고적일치성교차.222례환자안계화실시수술,6례환자취소수술,MPI검사결과대수술계화유명현영향,이CTA검사결과대수술계화무명현영향.술후무심기결혈상관적심교통、심기경새급심원성사망병례,심혈관병발증포괄6례심쇠,4례방전급1례뇌경새.결론 MPI시관맥결혈평개적직접지표,능구준학예측위수술기관맥결혈풍험급예후,가사선출수요연지혹금기수술적병례,대우림상수술계화적취사구유중요삼고의의,유조우강저병발증、제고위수술기안전성.
Objective To explore clinic value of nuclear myocardiac perfusion imaging (MPI) in perioperative coronary risk assessment in patients with heart diseases planning arthroplasty,and compare the conformity and effect on surgery planning between MPI and coronary computed tomography angiogram (CTA).Methods Prospectively collect clinical data of 228 patients with heart diseases planning joint arthroplasty,all patients had MPI and CTA test to assess perioperative coronary risk.The conformity and effect on surgery planning between the MPI and CTA was analyzed,and the occurrence of cardio-vascular complication was recorded.Results MPI showed that 215 patients had no myocardial ischemia except for 13.CTA showed that 113 cases had no coronary stenosis,51 cases had light coronary stenosis,39 cases had middle coronary stenosis and 12 cases had severe coronary stenosis in patients with no myocardial ischemia.CTA also found that 3 cases had no coronary stenosis,4 cases had light coronary stenosis,3 cases had middle coronary stenosis and 3 cases had severe coronary stenosis in patients with myocardial ischemia.The conformity between MPI and CTA was low.222 patients had completed operation except for 6 cases.MPI rather than CTA had conspicuous effect on surgery planning.There was no angina,myocardial infarction or cardiac death associated with myocardial ischemia.The postoperative cardio-vascular complications included 6 cases of heart failure,4 cases of atrial fibrillation and 1 case of cerebral infarction.Conclusion MPI is a direct index to judge blood supply of the myocardium,which can exactly predict the risk of perioperative myocardial ischemia and the prognosis.It's helpful for preoperative planning,reducing risk of perioperative complications through screening and excluding high-risk patients.