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目的探讨放射性核素~(99m)Tc-标记红细胞(~(99m)Tc-RBC)显像在消化道出血急重症患者中的临床价值以及影响因素。方法选取本院2012年7月至2016年2月54例临床诊断为消化道出血患者,进行消化道出血放射性核素显像检查,其中49例接受了消化道内窥镜检查,33例接受了CT相关检查,12例接受了手术治疗。采用体外法标记红细胞(~(99m)Tc-RBC),行腹盆部前后位图像采集,至有阳性结果,如无阳性结果则延迟至24小时。结果所收录患者均为急性起病,或慢性病程急性发作,因合并急性冠脉综合征、出血性休克、急性肠梗阻以及其他需要抢救的重症患者共31例;54例患者行核素消化道出血显像,检查阳性为44例,阳性率为81.5%,敏感性为97.7%,特异性为81.8%。33例接受CT相关检查,15例阳性,阳性率为45.4%。49例接受内窥镜检查,阳性38例,阳性率为77.6%。44例阳性患者中,提示胃及十二指肠阳性11例,提示小肠阳性25例,提示结肠阳性4例,全消化道多处阳性4例。其中26例经相应部位内镜检查和(或)手术证实,7例没有行相应部位内镜检查,11例仅提示存在消化道出血却无法准确定位,定位有效性为70.3%。结论核素消化道出血显像方便、快捷,覆盖面积大,能够指导急性消化道出血的精准检测及治疗。患者病情允许下可暂停止血药以提高检出率。
Objective To investigate the clinical value and influencing factors of radionuclide ~ (99m) Tc-labeled erythrocytes (~ (99m) Tc-RBC) imaging in patients with acute gastrointestinal hemorrhage. Methods From July 2012 to February 2016, 54 cases of patients with gastrointestinal bleeding who were diagnosed as gastrointestinal bleeding were enrolled in this study. Gastrointestinal hemorrhage radionuclide imaging was performed in 49 patients, of which 49 patients underwent endoscopy and 33 patients underwent CT Related tests, 12 patients underwent surgical treatment. The red blood cells (~ (99m) Tc-RBC) were labeled by in vitro method, and the anterior and posterior images of the abdominal pelvic area were collected to obtain a positive result. If there was no positive result, the result was delayed to 24 hours. Results The patients included were either acute onset or acute episode of chronic disease. There were 31 patients with acute coronary syndrome, hemorrhagic shock, acute intestinal obstruction and other critically ill patients requiring salvage. 54 patients underwent radionuclide Hemorrhage imaging, check positive for 44 cases, the positive rate was 81.5%, the sensitivity was 97.7%, the specificity was 81.8%. 33 cases underwent CT-related examination, 15 cases were positive, the positive rate was 45.4%. 49 cases accepted endoscopy, positive in 38 cases, the positive rate was 77.6%. Of the 44 positive patients, 11 were positive for stomach and duodenum, suggesting that 25 were positive for small intestine, 4 were positive for colon, and 4 were positive for multiple digestive tract. Twenty-six cases were confirmed by endoscopy and / or surgery. No endoscopic examination was performed in the seven cases, while only 11 cases were suggestive of gastrointestinal hemorrhage but could not be accurately located. The localization validity was 70.3%. Conclusions Nuclide gastrointestinal bleeding imaging is convenient, quick, covering a large area, can guide the precise detection and treatment of acute gastrointestinal bleeding. The patient’s condition allows to stop the hemostatic drugs to improve the detection rate.