SPECT在冠狀動脈慢性閉塞病變介入治療的應(yīng)用研究
發(fā)布時間：2018-09-05 13:00
【摘要】：[目的]冠狀動脈慢性閉塞病變(Chronic total occlusion,CTO)是冠心病中一類特殊病變,關(guān)于該病的治療方法及療效學(xué)術(shù)界尚存爭議。本課題主要利用單光子發(fā)射計算機斷層掃描(SPECT)核素心肌灌注顯像技術(shù)觀察CTO患者經(jīng)皮冠狀動脈介入治療(Percutaneous Coronary Intervention,PCI)治療后存活心肌恢復(fù)情況,評價CTO-PCI的治療效果,為CTO治療的合理決策提供依據(jù)。[方法]以2015年7月至2016年10月期間在昆明醫(yī)科大學(xué)第一附屬醫(yī)院心臟內(nèi)科住院治療,住院前曾行冠脈造影證實存在冠狀動脈閉塞病變且病變存在時間大于等于3個月的患者為研究對象。收集患者基本資料,包括人口學(xué)特征、既往病史、心絞痛癥狀、心功能情況、術(shù)前SPECT心肌核素灌注顯像、術(shù)前心電圖、術(shù)前心臟超聲、腎功能等臨床資料。完成冠脈造影及介入治療開通閉塞血管,剔除手術(shù)失敗及處理非閉塞血管的患者。術(shù)后3個月隨訪心絞痛癥狀、心功能情況,并復(fù)查心肌核素灌注顯像、心電圖、心臟超聲、腎功能等檢查。對入組患者繼續(xù)行電話或門診隨訪≥6個月,觀察患者遠(yuǎn)期嚴(yán)重不良心血管事件(Major Adverse Cardiac Events,MACE)事件發(fā)生情況。用SPSS17.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行分析,對手術(shù)前后臨床資料及心肌灌注情況進(jìn)行相關(guān)性分析,以P0.05判為有統(tǒng)計學(xué)意義。[結(jié)果]1.共納入研究對象26例,實際完成隨訪26例。患者手術(shù)前后心肌灌注、心功能情況、心絞痛癥狀、室壁運動情況均有明顯改善(P0.05)。2.手術(shù)前后心肌灌注情況與手術(shù)前后心功能情況有相關(guān)性(p0.05),手術(shù)前后心肌灌注情況與手術(shù)前后心絞痛癥狀無相關(guān)性(P0.05),術(shù)后心肌灌注恢復(fù)程度與患者側(cè)支循環(huán)質(zhì)量(rentrop分級)呈顯著負(fù)相關(guān)(P0.01)。[結(jié)論]1.成功的CTO-PCI治療能使CTO患者心肌灌注恢復(fù)、心功能改善、心絞痛癥狀程度減輕。2.成功的CTO-PCI治療后,患者心肌灌注恢復(fù)越多,心功能改善情況越好。3.CTO病變術(shù)前側(cè)支循環(huán)建立越差,PCI術(shù)后患者心肌灌注改善程度越好。
[Abstract]:Objective: chronic coronary artery occlusion (Chronic total occlusion,CTO) is a special disease in coronary heart disease. In this study, single photon emission computed tomography (SPECT) myocardial perfusion imaging was used to observe the recovery of viable myocardium after percutaneous coronary intervention (Percutaneous Coronary Intervention,PCI) in patients with CTO, and to evaluate the therapeutic effect of CTO-PCI. To provide the basis for the rational decision of CTO treatment. [methods] from July 2015 to October 2016, the patients were hospitalized in Department of Cardiology, the first affiliated Hospital of Kunming Medical University. Coronary arteriography was performed before hospitalization to confirm the presence of coronary artery occlusion and the duration of coronary artery occlusion was more than 3 months. The basic data of the patients were collected, including demographic characteristics, past medical history, symptoms of angina pectoris, cardiac function, preoperative SPECT myocardial radionuclide perfusion imaging, preoperative electrocardiogram, preoperative echocardiography, renal function and so on. Complete coronary angiography and interventional therapy to open occluded blood vessels, remove the failure of operation and deal with non-occlusive blood vessels. The symptoms of angina pectoris, cardiac function, myocardial radionuclide perfusion imaging, electrocardiogram, echocardiography and renal function were followed up 3 months after operation. The patients were followed up by telephone or outpatient for more than 6 months to observe the occurrence of long-term severe adverse cardiovascular events (Major Adverse Cardiac Events,MACE). SPSS17.0 statistical software was used to analyze the data, the clinical data and myocardial perfusion were analyzed before and after operation, with P0.05 as the statistical significance. [result] 1. A total of 26 cases were included in the study, and 26 cases were followed up. Myocardial perfusion, cardiac function, angina pectoris and wall motion were significantly improved before and after operation (P0.05). There was a correlation between myocardial perfusion and cardiac function before and after operation (p0.05), but no correlation between myocardial perfusion and angina pectoris before and after operation (P0.05). The degree of myocardial perfusion and the quality of collateral circulation (rentrop) after operation were not correlated (P0.05). There was a significant negative correlation (P0.01). [conclusion] 1. Successful CTO-PCI therapy can restore myocardial perfusion, improve cardiac function and alleviate angina pectoris symptoms in patients with CTO. After successful CTO-PCI treatment, the more myocardial perfusion recovery, the better the improvement of cardiac function. 3. The worse the establishment of collateral circulation before and after CTO-PCI, the better the degree of improvement of myocardial perfusion.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
本文編號：2224353
[Abstract]:Objective: chronic coronary artery occlusion (Chronic total occlusion,CTO) is a special disease in coronary heart disease. In this study, single photon emission computed tomography (SPECT) myocardial perfusion imaging was used to observe the recovery of viable myocardium after percutaneous coronary intervention (Percutaneous Coronary Intervention,PCI) in patients with CTO, and to evaluate the therapeutic effect of CTO-PCI. To provide the basis for the rational decision of CTO treatment. [methods] from July 2015 to October 2016, the patients were hospitalized in Department of Cardiology, the first affiliated Hospital of Kunming Medical University. Coronary arteriography was performed before hospitalization to confirm the presence of coronary artery occlusion and the duration of coronary artery occlusion was more than 3 months. The basic data of the patients were collected, including demographic characteristics, past medical history, symptoms of angina pectoris, cardiac function, preoperative SPECT myocardial radionuclide perfusion imaging, preoperative electrocardiogram, preoperative echocardiography, renal function and so on. Complete coronary angiography and interventional therapy to open occluded blood vessels, remove the failure of operation and deal with non-occlusive blood vessels. The symptoms of angina pectoris, cardiac function, myocardial radionuclide perfusion imaging, electrocardiogram, echocardiography and renal function were followed up 3 months after operation. The patients were followed up by telephone or outpatient for more than 6 months to observe the occurrence of long-term severe adverse cardiovascular events (Major Adverse Cardiac Events,MACE). SPSS17.0 statistical software was used to analyze the data, the clinical data and myocardial perfusion were analyzed before and after operation, with P0.05 as the statistical significance. [result] 1. A total of 26 cases were included in the study, and 26 cases were followed up. Myocardial perfusion, cardiac function, angina pectoris and wall motion were significantly improved before and after operation (P0.05). There was a correlation between myocardial perfusion and cardiac function before and after operation (p0.05), but no correlation between myocardial perfusion and angina pectoris before and after operation (P0.05). The degree of myocardial perfusion and the quality of collateral circulation (rentrop) after operation were not correlated (P0.05). There was a significant negative correlation (P0.01). [conclusion] 1. Successful CTO-PCI therapy can restore myocardial perfusion, improve cardiac function and alleviate angina pectoris symptoms in patients with CTO. After successful CTO-PCI treatment, the more myocardial perfusion recovery, the better the improvement of cardiac function. 3. The worse the establishment of collateral circulation before and after CTO-PCI, the better the degree of improvement of myocardial perfusion.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
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