对比剂增强的磁共振显像对心肌梗死后坏死心肌的检测_医学论文.docVIP

对比剂增强的磁共振显像对心肌梗死后坏死心肌的检测_医学论文 对比剂增强的磁共振显像对心肌梗死后坏死心肌的检测_医学论文 【关键词】 心肌梗死；坏死心肌；磁共振显像；钆喷酸葡胺猪 　　[摘要]目的评价对比剂增强的磁共振显像（CEMRI）对急性和陈旧性心肌梗死后坏死心肌检测的准确性。方法采用导管介入球囊封堵冠脉的方法制作9头苏中猪心肌梗死模型，随机分为两组（急性心梗组和陈旧性心梗组），分别于术后3d和3周行CEMRI和病理学检查。结果两组猪心脏磁共振检查均见心肌的延迟增强显像。病理TTC染色证实，延迟增强区系坏死心肌。结论CEMRI能够较准确地判断急性和陈旧性心肌梗死后坏死心肌及其范围。 　　[关键词]心肌梗死；坏死心肌；磁共振显像；钆喷酸葡胺猪 　　Experimental study to identify necrotic myocardium in acute and chronic myocardial infarction by contrastenhanced magnetic resonance imaging 　　Abstract: Objective To study the accuracy of contrastenhanced magnetic resonance imaging in identifying necrotic myocardium in acute and chronic myocardial infarction by experimental study. MethodsThe left anterior descending coronary was obstructed through catheter balloon. Then after three days and three weeks later, 9 pigs underwent contrastenhanced magnetic resonance imaging and pathological examination respectively. ResultDelayed enhancement signal was found in acute and chronic myocardial infarction, which was confirmed as necrotic myocardium in pathology by TTC staining. ConclusionContrastenhanced magnetic resonance imaging can identify the existence and the size of necrotic myocardium in acute and chronic myocardium infarction. 　　Key words: myocardial infarction necrotic myocardiummagnetic resonance imaging gadoliniumdiethyenetriamin epentaacetic acid pigs(Modern Medical Journal,2007,35:46) 　　冠心病心肌梗死（心梗）严重威胁着人类健康，发生心梗的心肌节段在血运重建术后其收缩功能是否能改善，主要取决于心梗后坏死心肌的范围和透壁程度；当坏死心肌的透壁程度＞75%时，血运重建术后仅2%的心肌节段能恢复功能；而透壁程度＜25%时，有78%的心肌节段可恢复功能[1]。因此准确地判断心梗后坏死心肌的范围和透壁程度，可以指导治疗、评估预后。本研究旨在通过动物实验研究探讨对比剂增强的磁共振显像（contrastenhanced magnetic resonance imaging，CEMRI）检测急性和陈旧性心肌梗死后坏死心肌的准确性。 　　1 资料和方法 　　1.1 动物模型的制备25～27kg的苏中猪10头，雌雄不分。氯胺酮（10mg#12539kg-1）和阿托品（25μg#12539kg-1）肌注诱导麻醉，硫喷妥钠20mg#12539kg-1静滴维持。行心电监护、血压监测、气管插管，呼吸机辅助呼吸18次#12539min-1。经一侧颈总动脉穿刺，球囊介入封堵冠状动脉左前降支90min，冠状动脉造影（CAG）显示抽空球囊后球囊远端血管完全堵塞。随机选取5头猪作为急性心梗组，其中1头猪术后第1天突然死亡，剩下的4头猪于术后3d进行CEMRI和病理TTC（2%红四氮唑）染色检查；其余5头猪作为陈旧性心梗组，于术后3周进行CEMRI和病理TTC染色检查。 　　1.2 CEMRI技术采用Philips Intera 1