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Annals of Nuclear Medicine and Molecular Imaging

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篇名 Dobutamine鉈-201氯化亞鉈心臟斷層檢查診斷冠狀動脈疾病的臨床效益
卷期 16:4
並列篇名 Clinical Efficacy of Dobutamine 201Tl-Thallous Chloride Myocardial Perfusion SPECT in Diagnosis of Coronary Artery Disease
作者 林明賢曹勤和洪慧意鄭澄意留以堅柯景塘
頁次 171-178
關鍵字 鉈 201氯化亞鉈冠狀動脈疾病斷層檢查Dobutamine201Tl TlClCoronary artery diseaseSPECT
出刊日期 200312

中文摘要

式。心臟催迫性藥物如doburamine、dipyridamole及adenosine已被用於無法以履帶式運動達到心臟壓力狀態的替代方法。Dobutamine藉由增加心跳、心臟收縮力和動脈血壓來增加心肌氧氣消耗,與履帶式運動心電圖類似,較合乎生理。dipyridamole及adenosine則是增加冠動動脈擴張以產生竊取現象(steal phenomenon),但不適用於慢性阻塞性肺病變及氣喘。本研究滿的在評估dobutamine鉈-201心臟斷層檢查(DTS)診斷冠狀動脈疾病(CAD)之臨床效益。
方法:從1995年6月至1996年8月 890位病例(男476人,平均平齡64±12歲;女414人,平均年齡65±10歲)臨床上懷疑CAD且因下肢關節疾病、年紀太大、慢性阻塞肺病變及氣喘而接受DTS檢查。dobutamine注射劑量是以高測量(10,20,30 μ/g/kg/min)每二分半鐘間隔遞增,當有下列情現時即終止注射dobutamine: (1)達到最大心跳的85%以上,(2)心絞病症狀產生,(3)產生頻繁心室律不整,(4)心電圖於J後有大於1.5 mm ST segment下降。終止後立即以78 MBq)2 mCi)的鉈-201靜脈注射,5分鐘後開始造影。DTS結果以雙盲方式由二位核醫專科醫師判讀,利用Cedar-Sinai polar map及三度空間影像處理程式,輔助判讀。
結果:890案例中有168位(19%)登錄dobutamine檢查過程中的副作用:心室律不速151位(17%)、胸悶142位(16%)、胸痛107位(12%)、喘80位(9%)、頭痛80位(9%)、高血壓53位(6%)、頭暈27位(3%)、噁心27位(3%),這些症狀於位子dobutamine注射即消失。有一位死亡案例,此案例為一早發性CAD,於檢查時急性心肌梗塞,經解剖證實三條冠動動脈有嚴重動脈硬化,幾乎達到完全阻塞的地步。總共有89位(10%)患者接受心導管檢查,以大於50%管徑的狹窄(stenosis)為陽性,其中單一血管CAD者有20例兩條血管CAD者有16例,三條血管CAD者有6例。利用DTS來偵測CAD的靈敏度(sensitivity)為83%,專一性(specificity)為79%,正確性(accuracy)為81%)。
結論:利用dobutamine的短半化期作用(約2分鐘),以dobutamine當催迫性藥物的鉈-201心臟掃描對於無法以跑步達到適當心臟壓力及氣喘患者,可提供一替代的準確且有效的冠動動脈疾病診斷工具。特別是對dipyridamole有禁忌的慢性阻塞肺病變及氣喘患者,dobutamine鉈-201心臟掃瞄是首選。但對於早發性冠狀動脈疾病則須特別注意,以免發生併發症。

英文摘要

Objective: Pharmacological stress including dobutamine, dipyridamoleand adenosine has been used in those patients who cannot perform treadmill exercise test. The aim of this study is to access the clinical efficacy of dobutamine 201TI-thallous chloride (200TI) myocardial perfusion study (DTS) in the diagnosis of coronary artery disease (CAD).
Methods: From Jun. 1995 to Aug. 1996, there were 890 subjects of suspicious CAD (476 men, mean±SD, 64±12 years; 414 women, mean±SD, 65±10 years) performing DTS due to (1) lower leg arthropathy (2) aged patients and (3) chronic obstructive pulmonary disease and asthma. The beta-blockers and calcium channel blockers were withheld for 24 h before the study. High dose of dobutamine (10, 20, 30 μg/kg/min) was infused intravenously in an interval of 2.5 min. If the heart rate was less than 100 beats per minute or twice as baseline, atropine 0.6mg was given. Dobitamine was stopped when: (1)reaching 85% of maximal predicted heart rate; (2)angina; (3)recurrent ventricular arrhythmia; (4)greater than 1.5 mm ST segment depression post point on EKG. The imaging was performed 5 min after infusion of 74 MBq (2 mCi) of 200TI with an Elschint SP-6 qamma camera equipped with a high resolution collimator under condition of 64×64 matrix frame size. A frame per 3° from RAO to LPO and 62frames were obtained from SPECT. The images were processed by Cedar-Sinai polar map and three-dimensional programs.
Results: Eighty-nine patients underwent cardiac catheterization: 20 patients were one-vessel diseases, 16 subjects were two-vessel disease, and 6with three-vessel diseases. The DTS study revealed 83% in sensitivity, 79% in specificity and 81% in accuracy in diagnosis of CAD. 168 (19%) of the total 890 subjects had adverse reactions including arrhythmia 151(17%), chest tightness 142 (16%), chest pain 107 (12%), dyspnea 80 (9%), headache 80(9%), hypertension 53 (6%), dizziness 27 (3%), and nausea 27 (3%). These symptoms disappeared when the dobutamine infusion was stopped. One expired subject was a victim of premature CAD who suffered from acute myocardial infarction in the examination. At autopsy, severe arterioscherosis and almost near total occlusions of the three coronary arteries were found.
Conclusions: On account of the short half-life of dobutamine (about 2 min), dobutamine 201TI myocardial perfusion study is an accurate and effective diagnostic modality for coronary artery disease when the patient cannot perform the treadmill exercise test or who were a victim of COPD or asthma.

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