摘要
目的 探讨消化道出血放射性核素^99m锝标记的红细胞（^99mTc-RBC）显像的临床价值及影响因素。方法 对临床确诊为消化道出血的98例患者，进行^99mTc-RBC消化道显像，以首次发现腹部异常浓聚区并沿肠道下移且随时间逐渐增浓者诊断为出血。同时观察止血药对其临床价值的影响。并比较^99mTc-RBC消化道显像、X线消化道钡剂造影、内窥镜检查及选择性血管造影之间的差别。结果 ^99mTc-RBC消化道显像的灵敏度为73．5％。72例阳性者中，显像发现的出血部位与病变部位相符者63例，定位准确率为87．5％（63/72），方法学的优化可以明显提高定位的准确率。同时显示^99mTc-RBC显像诊断消化道出血的临床意义明显高于X线消化道钡剂造影25．5％（12／47）、内窥镜检查31．4％（22／70）及选择性血管造影50．0％（6／12）。但检查的阳性率受止血药的影响，应用止血药前、后^99mTc-RBC显像的阳性率分别为95．6％（44／46）和53．8％（28／52），两者差异具有统计学意义（P〈0．05）。结论 ^99mTc-RBC显像对消化道出血定位诊断有较高的灵敏度和准确率，尤其对慢性间歇性、少量出血和病情危重不宜用创伤性检查者，但受止血药的影响。为提高检出率，在病情许可的情况下应暂缓应用止血药。
Objective To determine the value of ^99m Tc-RBC scintigraphy in diagnosis of gastrointestinal bleeding. Method Ninety-eight patients with clinieal evidenee of gastrointestinal bleeding had undergone eonventional gastrointestinal seintigraphy with ^99m Tc-RBC. The diagnostie criterion of seintigraphy for gastrointestinal bleeding was abnormal radioaetive accumulated in the abdomen, whieh extended to the dependent portion of intestine and gradually thiekened with the time. Simultaneously the effeet of a hemostat was observed. The eomparisons between ^99m Tc-RBC scintigraphy and X-ray gastrointestinal traek double- eontrast barium meal tomography, endoscopy as well as angiography were made. Results Seventy-two patients had revealed bleeding. The diagnostie accuraey of ^99m Tc-RBC scintigraphy was 73.5%. In 63 of 72 ^99m Tc-RBC scintigraphy positive patients, the bleeding site determined by ^99m Tc-RBC scintigraphy were eonsistent with the pathologieal identification. Therefore 87.5 % （63/72） of positive patients had precisely localized the bleeding site. ^99m Tc-RBC scintigraphy for diagnosis and localization of gastrointestinal bleeding had a superior sensitivity over X-ray double - contrast barium meal tomography of gastrointestinal traek 25.5% （12/47）, endoscopy 31.4% （22/70） and angiography 50.0% （6/12）. However, the positive aeeuraey was affeeted by influenee of hemostat. The diagnostic sensitivity was dropped from 95.6 % （44/46） to 53.8 % （28/52） before and after using hemostat. The drop rate was evidently higher （P 〈 0.05）. Conclusions ^99mTc-RBC seintigraphy as a reliable noninvasive test for diagnosing gastrointestinal bleeding was sensitive and aeeurate. Specially it benefited the patients with ehrunie and interval bleeding, small amount of bleeding and eritically ill who were unable to have invasive examination. In order to avoid the affection of hemostat and to inerease the sensitivity of ^99mTc-RBC seintigraphy diagnosing for gastrointestinal bleeding, according to the patients＇ condition, the postponement of using hemostat was suggested.
出处
《中华急诊医学杂志》
CAS
CSCD
2007年第1期60-64,共5页
Chinese Journal of Emergency Medicine
