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  本文選題：冠心病　切入點：體層攝影術　出處：《山東大學》2012年碩士論文　論文類型：學位論文

【摘要】：研究一目的：探討研究血管擴張劑對多層螺旋CT冠狀動脈成像質(zhì)量及血管管腔的影響。方法：隨機選取200例在我院行64排螺旋CT冠狀動脈成像的疑似冠心病患者,其中不使用硝酸甘油噴霧劑組(A組)和使用硝酸甘油噴霧劑組(B組)各100例,根據(jù)美國心臟病協(xié)會(AHA)的冠狀動脈分段標準分別測量兩組受檢者右冠狀動脈(1、2、3段)、后降支(4段)、左主干(5段)、左前降支(6、7、8段)、左旋支(11、13段)各血管節(jié)段的管腔直徑,統(tǒng)計分析兩組冠狀動脈各分支的成像質(zhì)量,并觀測B組使用硝酸甘油后的副作用出現(xiàn)率。結(jié)果：經(jīng)統(tǒng)計學分析,兩組間冠狀動脈各主要血管節(jié)段管腔直徑及小分支顯示率的差異有統(tǒng)計學意義,B組明顯大于A組；兩組間副作用出現(xiàn)率無顯著差異。結(jié)論：使用硝酸甘油可明顯擴張冠狀動脈血管,提高冠狀動脈分支的顯示,而副作用的出現(xiàn)率無顯著增高。 研究二目的：以選擇性冠狀動脈造影(SCA)結(jié)果為標準評價血管擴張劑對多層螺旋CT冠狀動脈成像狹窄度評估準確性的影響。方法：隨機選取2009年至2011年行MSCT冠狀動脈檢查的冠心病患者150例,分為A組(不使用硝酸甘油,75例)和B組(使用硝酸甘油,75例),測量不同性質(zhì)斑塊處冠狀動脈的狹窄程度,并分別與患者近期SCA檢查結(jié)果對比分析。結(jié)果：與SCA結(jié)果比較,對于非鈣化斑塊和以非鈣化成分為主的混合斑塊A組MSCT對狹窄程度有一定的低估,B組MSCT對狹窄程度有一定的高估,A、B組偏差分別約為-10.11%、+10.54%；對于鈣化斑塊和以鈣化成分為主的混合斑塊兩組MSCT對狹窄程度均有一定的高估,A、B組偏差分別約為+8.65%、+16.37%；兩組間的差異有統(tǒng)計學意義。A、B組MSCT與SCA測量結(jié)果間均有較好的相關性,兩組間相關系數(shù)的差異無統(tǒng)計學意義。結(jié)論：多層螺旋CT冠狀動脈成像檢查中使用血管擴張劑會對狹窄程度的評估偏高。 研究三目的：監(jiān)測冠心病患者經(jīng)內(nèi)科藥物治療后冠狀動脈斑塊的變化,評價多層螺旋CT在冠狀動脈粥樣斑塊隨訪中的應用價值。方法：收集自2009年至2011年間冠脈斑塊陽性、采用內(nèi)科保守治療、且行2次以上多層冠狀動脈冠狀動脈CTA檢查的患者,2次檢查間隔6～18個月,測量前后2次檢查非鈣化斑塊和以非鈣化成分為主的混合斑塊的體積變化并進行統(tǒng)計學分析。結(jié)果：患者前、后兩次檢查非鈣化斑塊及以非鈣化成分為主的混合斑塊總體積分別為1542.0mm3、1085.13mm3,經(jīng)內(nèi)科保守治療6～18個月后斑塊負荷降低,前后2次檢查問的差異有統(tǒng)計學意義。結(jié)論：內(nèi)科藥物治療可有效控制冠心病患者病情的進展,并可以降低冠狀動脈非鈣化斑塊的負荷。64層螺旋CT在冠狀動脈斑塊的隨訪中有重要的應用價值。
[Abstract]:Objective: to investigate the effect of vasodilators on coronary artery imaging quality and vascular lumen in multi-slice spiral CT. Methods: 200 suspected coronary artery disease patients who underwent 64-slice spiral CT coronary angiography in our hospital were randomly selected. Of them, 100 cases were treated with nitroglycerin spray group (group A) and 100 cases with nitroglycerin spray group (group B). The lumen diameters of each segment were measured according to the AHA-American Heart Association (AHA) standard. The diameter of each segment was measured in two groups: right coronary artery, right coronary artery, posterior descending artery, left main trunk, left anterior descending branch, left anterior descending branch, left anterior descending branch, left anterior descending branch, left circumflex branch, and left circumflex branch, respectively, 3 segments of right coronary artery, 4 segments of posterior descending branch, 5 segments of left main trunk, 8 segments of left anterior descending branch, 1113 segment of left circumflex branch. The imaging quality of each branch of coronary artery in two groups was statistically analyzed, and the side effects of nitroglycerin in group B were observed. There were significant differences in lumen diameter and small branch display rate between the two groups. Group B was significantly larger than group A. Conclusion: nitroglycerin can significantly dilate coronary artery and improve the display of coronary artery branch, but the occurrence rate of side effect is not significantly increased. Objective: to evaluate the effect of vasodilators on the accuracy of coronary artery stenosis in multi-slice spiral CT angiography using selective coronary angiography (SCA) as a standard. Methods: MSCT corona was performed from 2009 to 2011 at random. 150 patients with coronary artery disease, Group A (75 cases without nitroglycerin) and group B (75 cases with nitroglycerin) were divided into two groups: coronary artery stenosis at different plaques was measured, and the results were compared with recent SCA findings. Results: the results were compared with those of SCA. For non-calcified plaques and mixed plaques with non-calcified components, MSCT had a certain degree of underestimation to the degree of stenosis. The deviation of MSCT in group B for the degree of stenosis was -10.11 and 10.54, respectively, for calcified plaques and calcified plaques. The deviation of MSCT in group B was about 8.65 and 16.37, respectively, and the difference between the two groups was statistically significant. There was a good correlation between the results of MSCT and SCA in group A and B. Conclusion: the use of vasodilators in multi-slice spiral CT coronary artery imaging can be used to evaluate the degree of stenosis. Objective: to monitor the changes of coronary plaque in patients with coronary artery disease after medical treatment, and to evaluate the value of multislice spiral CT in the follow-up of coronary atherosclerotic plaque. Methods: from 2009 to 2011, coronary plaque positive was collected. Patients who received conservative medical treatment and performed more than 2 multilayer coronary artery CTA examinations had an interval of 618 months. The volume changes of noncalcified plaques and mixed plaques with noncalcified components were measured and analyzed statistically. The total volume of noncalcified plaques and mixed plaques with noncalcified components were 1 542.0 mm 31085.13 mm 3 respectively. The plaque load decreased after 6 ~ 18 months of conservative treatment. Conclusion: medical treatment can effectively control the progress of coronary heart disease. It can reduce the load of coronary artery non-calcified plaque. 64 slice spiral CT has important application value in the follow-up of coronary artery plaque.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R541.4;R816.2

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