肺灌注断层显像评价肺动脉血栓内膜剥脱术对慢性血栓栓塞性肺动脉高压的疗效

发布时间：2018-05-28 23:24

  本文选题：高血压 + 肺　； 参考：《中国医学影像技术》2017年08期

【摘要】：目的采用~(99)Tc~m-人体大颗粒聚合白蛋白(~(99)Tc~m-MAA)肺灌注断层显像评价肺动脉血栓内膜剥脱术(PTE)对慢性血栓栓塞性肺动脉高压(CTEPH)的疗效。方法对16例CTEPH患者分别于术前、术后6~12个月行肺灌注断层显像,观察术前、术后肺叶、肺段灌注病变及改善情况,计算全肺灌注缺损百分比(PPDs%),并采用超声心动图观察术前、术后肺动脉收缩压(SPAP)的变化。结果 16例患者术后SPAP[(36.56±8.47)mmHg]较术前[(90.52±14.55)mm-Hg]明显减低(t=14.14,P0.001)。PTE术前16例患者的96个肺叶中有86个(86/96,89.58%)存在灌注异常,术后完全改善、部分改善的肺叶分别为21个(21/86,24.42%)、65个(65/86,75.58%);术前16例患者的304个肺段中,230个(230/304,75.66%)肺段灌注异常,术后完全改善、部分改善和未改善的肺段分别为73个(73/230,31.74%)、74个(74/230,32.17%)和83个(83/230,36.09%)。术前PPDs%为(56.79±14.54)%,术后6~12个月降低为(28.20±15.24)%(t=8.13,P0.001)。PPDs%与同期SPAP呈正相关(r=0.68,P0.001)。结论 PTE可使CTEPH患者的SPAP明显降低,肺血流灌注明显改善,肺灌注显像可有效评价PTE疗效。
[Abstract]:Objective to evaluate the efficacy of pulmonary perfusion tomography (PTET) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) by using the lung perfusion tomography (SPECT). Methods Pulmonary perfusion tomography was performed in 16 patients with CTEPH before operation and 6 ~ 12 months after operation. The pulmonary lobes and lung segment perfusion lesions were observed before and after operation. The percentage of total pulmonary perfusion defect was calculated and the preoperative echocardiography was used to observe the preoperation. Changes of pulmonary systolic blood pressure (spp) after operation. Results SPAP [36.56 卤8.47)mmHg] in 16 patients after operation was significantly lower than that before operation [90.52 卤14.55)mm-Hg]. 86 of 96 pulmonary lobes (86 / 96, 89.58) had abnormal perfusion, and there was complete improvement after operation. The partially improved lobes were 21 / 21 / 86 / 24.42, 65 / 65 / 86 / 86 / 75.58; of the 304 lung segments of 16 patients before operation, 230 / 230 / 304 / 75.66 had abnormal perfusion and completely improved after operation. The partial and unimproved lung segments were 73 / 23 / 230 / 31.74, 74 / 74 / 73032.17) and 83 / 833 / 30 / 36.09, respectively. Preoperative PPDs% was 56.79 卤14.54m and decreased to 28.20 卤15.24m per month after the operation. There was a positive correlation between PPDs% and SPAP in the same period. Conclusion PTE can significantly reduce SPAP and improve pulmonary perfusion in patients with CTEPH. Pulmonary perfusion imaging can effectively evaluate the efficacy of PTE.
【作者单位】： 首都医科大学附属北京朝阳医院核医学科;
【分类号】：R544.1;R817.4

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