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关键词：主动脉瘤；体层摄影术；发射型计算机；单光子；外科；手术；预后
王王金城
摘要 目的 探讨主动脉夹层动脉瘤患者术前行心肌SPECT显像的必要性。方法 30例经外科手术证实的主动脉夹层动脉瘤患者，术前均进行潘生丁负荷和静息心肌断层显像，2次显像间隔24h～1周，其中2例行冠状动脉造影检查。结果 30例病人中DebackeyⅠ型20例，Debackey Ⅲ型10例。19例心肌断层显像正常，其中18例手术成功，1例术后死于急性下壁心肌梗死，手术死亡率5.26%。11例病人心肌显像异常，其中5例手术成功，6例因术后心肌复跳无力或心功能低下死亡；6例中手术见DebackeyⅠ型5例，夹层裂口撕至右冠状动脉开口3例，夹层内充满血栓或粥样斑块2例,DebackeyⅢ型1例合并主动脉内膜粥样斑块形成，死亡率为54.55%。结论 主动脉夹层动脉瘤患者术前进行潘生丁负荷心肌断层显像，对临床判断其累及冠状动脉情况及手术预后非常必要。
The study of the necessity ofpreoperative myocardial SPECT imaging in patients with dissecting aneurysm of aorta
WANG Qian, WANG Jincheng.BeijingAnzhenhospital, Beijing 100029
Abstract Objective Tostudy the necessity of dipyrodamole stress myocardial SPECT imaging before the operationin patients with dissecting aneurysm of aorta.Methods 30 patients withdiagnosed dissecting aneurysm of aorta were included in this study.All of them underwentdipyridamole stress and rest myocardial SPECT imaging separately before operation with 1～7days' interval between two modalities.Two of the patients also underwent coronaryangiography.Results According to the findings in operation, of the 30patients, 20 belonged under Debackey Ⅰ and 10 under Debackey Ⅲ.In the 19 patients withnormal SPECT imaging, 18had successful operations while the remaining one died of acuteinferior wall infarction after operation.The mortality was 5.26%.In the 11 patients withabnormal SPECT imaging, 5had successful operations while 6 died of cardiac insufficiencyor low cardiac output syndrome.Of the 6 cases who died right in or after the operation, 5belonged to Debackey Ⅰ and 3had sandwiches torn to the opening of the right coronaryartery.Of these 3 patients, 2had the sandwiches filled with thrombi or atheromatousplaque, the other one belonged to Debackey Ⅲ accompained by the formation of aorticatheromatous plaque.The mortality was 54.55%.Conclusions Dipyridamolestress myocardial SPECT imaging is necessary for prognostication before operation forpatients with dissecting aneurysm of aorta, especially for patients belonging to DebackeyⅠ.
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