单光子发射计算机体层扫描对围手术期肺癌患者心肺功能的诊断价值研究

摘要

目的:探讨单光子发射计算机体层扫描(SPECT)心肌灌注显像对围手术期肺癌患者心肺功能评价的临床价值.方法:选取63例行手术治疗的肺癌患者,按照手术情况将其分为肺叶切除组(42l例)和全肺切除组(21例).两组患者均于术前采用肺功能分析仪行常规肺功能检查,获得第1秒用力呼气容积(FEV1).于手术前后10 d对所有患者行超声心动图检测、SPECT心肌灌注显像和SPECT肺部灌注显像检查;比较手术前后患者3种检查方法的左室射血分数(LVEF)、舒张末容积(LVEDV)、收缩末容积(LVESV)和FEV1等指标.结果:手术前心肌灌注显像正常患者50例(占79.37%),手术后心肌灌注显像正常患者34例(占53.97%),手术前后心肌灌注显像正常患者比较,差异有统计学意义(x2=9.143,P<0.05).手术后,两组患者左室射血分数(LVEF)较手术前有明显的降低,其差异均具有统计学意义(t=3.248,t=4.178;P<0.05);SPECT心肌灌注显像与超声心动图检测的左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)差异均无统计学意义;肺灌注显像FEV1预测值与肺功能分析仪实测值无差异,两者具有明显的正相关关系(r=0.6843,P<0.05).结论:SPECT灌注显像检查对围手术期肺癌患者心肺功能的预测较为准确、客观,具有一定的临床诊断价值.%Objective:To explore the clinical value of single-photon emission computed tomography (SPECT) for the evaluation of cardio-pulmonary function of perioperative patients with lung cancer.Methods: 63 patients with lung cancer received operative therapy were divided into pulmonary lobectomy group (421cases) and whole pneumonectomy group (21cases). Before operation, every patient of the two groups received routine detection of pulmonary function by using pulmonary function analyzer, and then their forced expiratory volume in one second (FEV1) were recorded. All of patients received detection of echocardiography, myocardial perfusion of SPECT and lung perfusion of SPECT pre-post operation 10 days. A series indicators including left ventricular ejection fraction(LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and FEV1 of three detection methods for patients were compared pre-and post operation.Results: There were 50 myocardial perfusion images normal (79.37%) before operation, while there were 34 myocardial perfusion images normal (53.97%) post-operative, and the difference between them was significant (x2=9.143,P=0.002). The LVEF of two groups post operation was significantly lower than that of pre- operation (t=3.248,P=0.002;t=4.178,P=0.000). However, the differences of LVEDV, LVESV and LVEF between echocardiography and myocardial perfusion of SPECT were no significant. Besides, the difference between predictive value for FEV1 of pulmonary perfusion imaging and the detection results of pulmonary function analyzer was no significant (P>0.05), and the positive correlation between them was significant (r=0.6843,P<0.05).Conclusion: It is relatively accuracy and objective that perfusion of SPECT predicts cardio-pulmonary function of perioperative patient with lung cancer. And it has diagnostic value in clinical practice.