血管擴張劑引起的副作用與心肌灌注掃描結果可逆性缺血的相關性

The Relationship between Side Effects Induced by Vasodilator and Reversibility of Myocardial Perfusion Scan

黃柏濤(Bor-Tau Hung) ； 湯淑雯(Shu-Wen Tang)

《核子醫學雜誌》 23卷2期 (2010/06) Pp. 65-69

https://doi.org/10.6332/ANMS.2302.001

摘要

背景：心肌灌注掃描(myocardial perfusion scan)廣泛應用於冠心症的診斷與療效評估，然而大部份的病患由於年紀大或退化性關節病變等因素必須使用血管擴張劑來達到預期的檢查效果，其中最常用的是dipyridamole。血管擴張劑的副作用中有些就像典型的心绞痛，其他症狀包括頭暈、肚子痛、想吐等。本研究探討心肌缺血的可通性與否和血管擴張劑的副作用之间的關連性。
方法：我們回顧過去半年到本科接受心肌灌注掃描的所有病人，將病人對血管擴張劑反應的主述區分爲三大類組：第一組的病人對注射藥物無不良反應；第二組的病人對注射藥物有不適反應，但非心絞痛的典型症狀；第三組的病人對注射藥物有典型心絞痛不舒服症狀。
結果：以卡方檢定統計比較出現典型心絞痛的病人和沒出現典型心絞痛的病人，前者有較高的比例呈現可逆性缺血。此外，年齡較小的病人比年齡較大的病人容易出現典型心絞痛，而且男性病人呈現可逆性缺血的比率比女性高。
結論：產生典型心絞痛症狀的病人比沒症狀或非典型症狀的病人，可逆性缺血的機率較高，而且可能意味著coronary steal所造成的真實心肌缺血。

關鍵字

血管擴張劑 ； 心肌灌注掃描 ； 心絞痛

並列摘要

Background: Myocardial perfusion scan is widely applied in the diagnosis and assessment of treatment response in patients with coronary arterial disease. However, vasodilator has to be used in most patients due to advancing age or degenerative joint disease to achieve adequate stress. Dipyridamole is among the most frequently used agents. Some side effects of vasodilator like typical angina while other symptoms include dizziness, abdominal pain, nausea, and so on. The aim of this study was to discuss the relationship between side effects induced by vasodilator and reversibility of myocardial perfusion scan.
Methods: We retrospectively reviewed all patients who received myocardial perfusion scan in our department during the past half an year and classified them into three categories according to their response to the vasodilator. Patients in category one have no symptoms, patients in category two have discomfort but not angina, and patients in category three have typical symptoms of angina.
Results: Chi-square test was used for statistical analysis. We found that patients with symptoms of typical angina were more likely to have reversible ischemia than patients without symptoms or with atypical symptoms. Besides, symptoms of typical angina were more likely to be observed in younger patients and male patients were more likely to have reversible ischemia than female patients.
Conclusion: Patients with symptoms of typical angina were more likely to have reversible ischemia than patients without symptoms or with atypical symptoms. This phenomenon may be explained by ”coronary steal”, a situation when true ischemia occurred.

並列關鍵字

vasodilator ； myocardial perfusion scan ； angina