经下腔静脉放置冠状静脉窦电极导管对操作者放射剂量影响的研究  

The impact on operator-incurred-radiation of coronary sinus catheter insertion through inferior vena cava approaches

作　　者：纳贝·哈力克[1] 杨龙[1] 郑黎晖[1] 陈文生[1] 黄雯[1] 牛国栋[1] 张奎俊[1] 姚焰[1] 

机构地区：[1]中国医学科学院心血管病研究所北京协和医学院阜外心血管病医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2010年第3期208-210,共3页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的经下腔静脉（IVC）放置冠状静脉窦（CS）电极导管理论上存在减少操作者放射剂量的可能性。本文在对比经IVC可调弯电极导管与经上腔静脉（SVC）固定弯电极导管置入CS操作的可行性和操作者所受的放射剂量。方法202例患者，经下腔静脉组（IVC组）122例、经上腔静脉组（SVC组）80例，两组患者年龄、性别、超声心动图和心律失常类型方面差异均无统计学意义。IVC组采用可控弯10极电极导管，SVC组使用固定弯10极电极导管，由同一组术者操作。记录两组患者导管放置时曝光时间，并测定操作者所受放射剂量。结果IVC组122例患者中有2例电极导管不能到位，改经SVC途径仍未成功；SVC组80例全部放置成功。两组平均每例曝光时间相似[（105±12）s vs（108±19）S；P=0．925]。单位时间所受放射剂量平均值在IVC组为0．25×10^-2uGy／s，SVC组为1．38×10～uGy／s。IVC组和SVC组操作者平均每例接受放射剂量分别为（0．30±0．04）uGy和（1．49±0．27）uGy（P〈0．001）。两组皆未发现心脏和血管并发症。结论与固定弯电极导管经SVC途径比较，可控弯电极导管经IVC途径置入CS电极导管的单位时间放射量明显降低，在不增加操作时间的同时可显著减少操作者所受放射剂量。Objective To evaluate and compare the dosages of operator-incurred-radiation during the implantation of coronary sinus （CS） catheter between the approaches through inferior vena cava （IVC） with the steerable catheter and through supra vena cava （SVC） with the fixed curve catheter. Methods Two hundred and two patients were divided into two groups according to the different approaches of CS catheter insertion. IVC group （n = 122） ：a deca-polar catheter with steerable curve was placed into CS through the femoral vein and the IVC. SVC group （ n = 80） ： a fixed curve deca-polar catheter was inserted into CS through the jugular vein and the SVC. There was no obvious difference in gender, age, and echocardiogram between the two groups. All proce- dures were performed by the same three operators. The exposure time of each case and the dosage of operator-in- curred-radiation during the procedure were measured. Results The catheters were positioned successfully inl20 patients in the IVC group and in all patients in the SVC group. The 2 failured in the IVC group were also failed in by attempting through SVC with fixed curve catheter. There was no significant difference in the expo- sure time between IVC group and SVC group [ （105 ± 12）s and （108 ± 19）s,P =0. 9251. The per sec opera- tor-incurred-radiation was 0. 25 × 10 -2 uGy/s in IVC group and 1.38 × 10 -2 uGy/s in SVC group. This lead to significant decrease in the dosage of operator-incurred-radiation in IVC group [ （0. 30 ± 0. 04）uGy vs （ 1.49 ±0. 27） uGy,P 〈 0. 0011- No cardiac or vascular complication was observed in both groups. Conclusions Insertion of coronary sinus catheter through IVC with the steerable catheter is associated with significantly less radiation than that through SVC with the fixed curve catheter without increasing time of the procedure.

关 键 词：冠状静脉窦 上腔静脉 下腔静脉 放射 

分 类 号：R541.7[医药卫生—心血管疾病]