تالیوم اسکن

  دکتر محمد کاظم قویدل متخصص قلب و عروق
 

 

با توجه به اينكه قلب عضو حساس بدن بشمار مي رود در صورت هر گونه اشكال در اين عضو خون رساني ، كليه بافتهاي بدن مختل شده لذا بافتهاي بدن از لحاظ اكسيژن و تغذيه دچار نقصان شده و ا گر اين روند ادامه پيدا كند به مرگ بافت و عضو و در نهايت بيمار منجر مي شود. لذا پيگيري بيماريهاي قلبي همانگونه كه عموم مردم در جريان اين امر هستند واجب و تشخيص زودتر بيماريهاي عروقي قلبي بصلاح است. در روش پزشكي هسته اي ماده راديواکتيو وارد بدن شده در قلب تجمع مي يابد با توجه به خونرساني خود قلب مشخص مي شود كه چه مقدار از بافت قلب ماده راديواكتيو را جذب كرده و كدام قسمتهاي قلب اين ماده را جذب نكرده است اسكن قلب با تزريق ماده راديواكتيو به اسم ‏MIBI-TC9900‏ در دو مرحله ورزش و مرحله استراحت انجام مي شود با توجه به اينكه در مرحله ورزش ، قلب در حال فعاليت مي باشد ضربان قلب بالارفته و عروق متسع مي شوند (به صورت طبيعي) اما در بيماري كه تنگي يكي از عروق قلبي را دارا است بدليلي اينكه قبلا اين عمل اتساع عروق به منظور جبران كاهش خونرساني به بافت قلب به صورت طبيعي اتفاق افتاده است لذا در مرحله تست ورزش با وجود اينكه ضربان قلب بالا رفته اما عروق مذكور اگر اتساع پيدا نمي كنند در نتيجه خون كمتري به بافتي از قلب كه از آن رگ خون مي گيرد مي رسد به اين حالت بيمار  مي گويند دچار ايسكمي شده است .

متخصص قلب و عروق و پرستاري مجرب بخش ‏ccu‏ در كنار شما هستند و هيچ خطري شما را تهديد نمي كند در اين موقع است که ماده راديواكتيو به شما در حين عمل تست ورزش تزريق مي شود تا بلافاصله به تمام قلب رفته و به جاهايي كه تنگي عروق دارند نيز عبور كرده در نتيجه جائي كه خون بيشتري به بافت قلب رفته باشد جذب ماده راديواکتيو بيشتر و جائي كه خون كمتري باشد جذب كمتري اتفاق مي افتد هنگام تست ورزش بيماران از لحاظ قلبي كامل مانيتورينگ مي شوند و هر گونه اختلال ‏ECG‏ (نوار قلب) آنها كامل بررسي شده و در صورت لزوم تست ورزش قطع خواهد شد . در بعضي از بيماران به علت مشكلات حركتي ناشي از آرتروز يا ديسك كمر يا به هر دليلي كه بيمار نتواند تست ورزش را اجرا كند به صورت جبراني از دارويي به نام دي پيريدآمول متناسب با وزن بيمار استفاده مي شود اين دارو نيز مشابه تست ورزش عروق خوني را متغير مي كند اما عوارضي همچون سردرد، سرگيجه حالت  تهوع و گرگرفتگي بدن دارد البته در همه بيماران اتفاق نمي افتد در صورت بوجود آمدن اين عوارض بعد از تزريق ماده راديواكتيو داروئي جهت برطرف كردن عوارض آن تزريق مي شود كه بيمار احساس امنيت بيشتري داشته باشد. مرحله بعدي مرحله استراحت است در اين مرحله قلب در حالت استراحت بررسي مي شود بيمار پس از ورود به بخش اسكن بعد از تزريق ماده راديواكتيو يك ليوان شيرخورده و منتظر مي ماند تا دارو كاملا جذب شده و شير كه تخليه كبد و كيسه صفرا را دارد تاثير خود را داشته باشد سپس به اتاق اسكن راهنمايي مي شود .

دسته بندي انجام اسكن قلب:

1- پذيرش

2- قطع داروهاي كاهش دهنده ضربان قلب و فشار خون از جمله پروپرانولول (ايندرال ) متورال - آتنولون و ...

موارد بالا در بيماراني است كه مرحله تست ورزش را دارند و قرار نيست با داروي دي پيريدامول تست ورزش شوند . در بيماراني كه طبق نظر پزشك معالج خودشان با تجويز دي پيريدآمول قرار است تست ورزش شوند نيازي به قطع موارد بالا نيست فقط در صورت مصرف قرصهاي آمينوفيلين و تئوفيلين قطع اين دو گزينه كافي بنظر مي رسد.

3- نخوردن چائي در روز اسكن

4- تراشيدن موهاي سينه در آقايان

5- ناشتا بودن

6- همراه داشتن يك پاكت شيرپرچرب

چون ماده راديواكتيو به مقداري در كبد جذب مي شود به منظور تخليه كبد كيسه صفرا از شير استفاده مي شود .

7- پوشيدن لباس راحت

8- نداشتن شيء فلزي در ناحيه قفسه سينه مثل گردنبندهاي بلند و سكه ، كليد در جيب  و سراخ و ...

9- همكاري با پرسنل جهت ارائه خدمات مفيدتر و بهتر شدن كيفيت تصوير بردار

چون اسكن حدود 27 دقيقه بطول مي انجامد در اين مدت بيمار بايد از هر گونه سرفه زدن حركت كردن و نفس عميق جلوگيري كند در غير اين صورت اسكن تكرار خواهد شد و در مراحل بعدي به عبور تخليه ماده راديواكتيو در روده بزرگ انجام اسكن با كيفيت بالا مسير نخواهد بود . ‏

 

مواد رعايت :

چون به بدن شما ماده راديواكتيو تزريق شده است در دو روز متوالي در نتيجه در طول اين مدت و 24 ساعت بعد از آن بيمار نبايد نزديك خانم حامله و بچه هاي زير 5 سال باشد حتي در موقع رفتن به دستشويي لازم است آب بيشتري بريزد اين داروي تزريق شده براي خود بيمار هيچ ضرورتي ندارد مقدار اشعه دريافتي بيمار به حدي است كه مي توان آنرا مقدار با مقدار اشعه عكسهاي راديولوژي مقايسه كرد كه هيچ مشكلي ايجاد نمي كند .

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