冠脉CT成像血管扩张剂的规范化应用及冠脉粥样硬化斑块的随访研究

发布时间：2018-03-03 15:05

本文选题：冠心病　切入点：体层摄影术　出处：《山东大学》2012年硕士论文　论文类型：学位论文

【摘要】：研究一目的：探讨研究血管扩张剂对多层螺旋CT冠状动脉成像质量及血管管腔的影响。方法：随机选取200例在我院行64排螺旋CT冠状动脉成像的疑似冠心病患者,其中不使用硝酸甘油喷雾剂组(A组)和使用硝酸甘油喷雾剂组(B组)各100例,根据美国心脏病协会(AHA)的冠状动脉分段标准分别测量两组受检者右冠状动脉(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)各血管节段的管腔直径,统计分析两组冠状动脉各分支的成像质量,并观测B组使用硝酸甘油后的副作用出现率。结果：经统计学分析,两组间冠状动脉各主要血管节段管腔直径及小分支显示率的差异有统计学意义,B组明显大于A组；两组间副作用出现率无显著差异。结论：使用硝酸甘油可明显扩张冠状动脉血管,提高冠状动脉分支的显示,而副作用的出现率无显著增高。研究二目的：以选择性冠状动脉造影(SCA)结果为标准评价血管扩张剂对多层螺旋CT冠状动脉成像狭窄度评估准确性的影响。方法：随机选取2009年至2011年行MSCT冠状动脉检查的冠心病患者150例,分为A组(不使用硝酸甘油,75例)和B组(使用硝酸甘油,75例),测量不同性质斑块处冠状动脉的狭窄程度,并分别与患者近期SCA检查结果对比分析。结果：与SCA结果比较,对于非钙化斑块和以非钙化成分为主的混合斑块A组MSCT对狭窄程度有一定的低估,B组MSCT对狭窄程度有一定的高估,A、B组偏差分别约为-10.11%、+10.54%；对于钙化斑块和以钙化成分为主的混合斑块两组MSCT对狭窄程度均有一定的高估,A、B组偏差分别约为+8.65%、+16.37%；两组间的差异有统计学意义。A、B组MSCT与SCA测量结果间均有较好的相关性,两组间相关系数的差异无统计学意义。结论：多层螺旋CT冠状动脉成像检查中使用血管扩张剂会对狭窄程度的评估偏高。研究三目的：监测冠心病患者经内科药物治疗后冠状动脉斑块的变化,评价多层螺旋CT在冠状动脉粥样斑块随访中的应用价值。方法：收集自2009年至2011年间冠脉斑块阳性、采用内科保守治疗、且行2次以上多层冠状动脉冠状动脉CTA检查的患者,2次检查间隔6～18个月,测量前后2次检查非钙化斑块和以非钙化成分为主的混合斑块的体积变化并进行统计学分析。结果：患者前、后两次检查非钙化斑块及以非钙化成分为主的混合斑块总体积分别为1542.0mm3、1085.13mm3,经内科保守治疗6～18个月后斑块负荷降低,前后2次检查问的差异有统计学意义。结论：内科药物治疗可有效控制冠心病患者病情的进展,并可以降低冠状动脉非钙化斑块的负荷。64层螺旋CT在冠状动脉斑块的随访中有重要的应用价值。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R541.4;R816.2

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