SPECT在冠状动脉慢性闭塞病变介入治疗的应用研究
发布时间：2018-09-05 13:00
【摘要】：[目的]冠状动脉慢性闭塞病变(Chronic total occlusion,CTO)是冠心病中一类特殊病变,关于该病的治疗方法及疗效学术界尚存争议。本课题主要利用单光子发射计算机断层扫描(SPECT)核素心肌灌注显像技术观察CTO患者经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)治疗后存活心肌恢复情况,评价CTO-PCI的治疗效果,为CTO治疗的合理决策提供依据。[方法]以2015年7月至2016年10月期间在昆明医科大学第一附属医院心脏内科住院治疗,住院前曾行冠脉造影证实存在冠状动脉闭塞病变且病变存在时间大于等于3个月的患者为研究对象。收集患者基本资料,包括人口学特征、既往病史、心绞痛症状、心功能情况、术前SPECT心肌核素灌注显像、术前心电图、术前心脏超声、肾功能等临床资料。完成冠脉造影及介入治疗开通闭塞血管,剔除手术失败及处理非闭塞血管的患者。术后3个月随访心绞痛症状、心功能情况,并复查心肌核素灌注显像、心电图、心脏超声、肾功能等检查。对入组患者继续行电话或门诊随访≥6个月,观察患者远期严重不良心血管事件(Major Adverse Cardiac Events,MACE)事件发生情况。用SPSS17.0统计软件对数据进行分析,对手术前后临床资料及心肌灌注情况进行相关性分析,以P0.05判为有统计学意义。[结果]1.共纳入研究对象26例,实际完成随访26例。患者手术前后心肌灌注、心功能情况、心绞痛症状、室壁运动情况均有明显改善(P0.05)。2.手术前后心肌灌注情况与手术前后心功能情况有相关性(p0.05),手术前后心肌灌注情况与手术前后心绞痛症状无相关性(P0.05),术后心肌灌注恢复程度与患者侧支循环质量(rentrop分级)呈显著负相关(P0.01)。[结论]1.成功的CTO-PCI治疗能使CTO患者心肌灌注恢复、心功能改善、心绞痛症状程度减轻。2.成功的CTO-PCI治疗后,患者心肌灌注恢复越多,心功能改善情况越好。3.CTO病变术前侧支循环建立越差,PCI术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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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