单光子发射计算机体层扫描对肺癌患者围手术期心脏功能评价的价值

摘要

Objective To investigate the clinical value of single photon emission computed tomography ( SPECT ) myocardial perfusion imaging in the evaluation of cardiac function in patients with lung cancer during perioperative period . Methods From January 2013 to January 2016 , in the Department of thoracic surgery of Handan Central Hospital , surgical treatment of 63 cases of patients with lung cancer , including lobectomy 42 cases, 21 cases of lung resection were enrolled , be-fore and after surgery around 10 d, SPECT myocardial perfusion imaging and echocardiography were performed , compared be-fore and after the operation of different examination methods of left ventricular ejection fraction ( LVEF) , end diastolic volume ( LVEDV) , end systolic volume ( LVESV) and other indicators ’ differences .Results Fifty myocardial perfusion images were normal (79.37%) before surgery, 34 myocardial perfusion images were normal (53.97%) post-operative (χ2 =9.143, P =0.002);After surgery, left ventricular ejection fraction (LVEF) compared with before surgery was significantly reduced (t =3.248, P =0.002;t =4.178, P =0.000), the difference between the two groups were statistically significant ( t =2.247, P =0.028);SPECT myocardial perfusion imaging and echocardiography left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF) were not statistically significant different ( P >0.05).Conclusion SPECT myocardial perfusion imaging to assess cardiac function in perioperative patients with lung cancer is more accurate and objective , and it is worth to be popularized in clinical application .%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脏功能评价的临床价值。方法选取2013年1月—2016年1月邯郸市中心医院胸外科行手术治疗的肺癌患者63例，其中肺叶切除组42例，全肺切除组21例，于术前及术后10 d行SPECT心肌灌注显像检查及超声心动图检测，比较手术前后不同检查方法的左室射血分数（ LVEF）、左室舒张末容积（ LVEDV）、左室收缩末容积（ LVESV）等指标差异。结果手术前心肌灌注显像正常者50例（79．37％），手术后心肌灌注显像正常者34例（53．97％），手术前后比较差异有统计学意义（χ2＝9．143， P ＝0．002）；手术后的心肌灌注显像评分低于手术前（ Z ＝10．286， P ＝0．036）；手术后，肺叶切除组和全肺切除组LVEDV、LVESV均呈不同程度的升高，但差异无统计学意义（ P ＞0．05）；LVEF较手术前有明显降低（ t ＝3．248， P ＝0．002；t ＝4．178， P ＝0．000），且全肺切除组低于肺叶切除组（ t ＝2．247， P ＝0．028）；SPECT心肌灌注显像与超声心动图检测的LVEDV、LVESV、LVEF差异均无统计学意义（ P ＞0．05）。结论 SPECT心肌灌注显像检查对围手术期肺癌患者心脏功能的评估较为准确、客观，值得在临床推广应用。