接受常规心脏介入放射诊疗患者的辐射剂量分析  

Investigation of dose to patients in conventional cardiac intervention

作　　者：张梦龙[1] 孙峰[1] 杨显存[2] 王刚[1] 

机构地区：[1]山东省医学影像学研究所,济南250021 [2]山东大学附属省立医院介入诊疗科

出　　处：《中华放射学杂志》2015年第9期670-674,共5页Chinese Journal of Radiology

基　　金：山东省医药卫生科技发展计划（2014ws0393）

摘　　要：目的探讨接受常规心脏介入诊疗患者的辐射剂量。方法回顾性分析成功行冠状动脉造影（CAG）、经皮腔内冠状动脉成形术（PTCA）和射频消融术（RF）之一的238例成年患者资料。按照患者接受的介入诊疗方式不同分组（77例行CAG，95例行PTCA，66例行RF），计算和测量辐射剂量，包括体表峰值剂量（PSD）、剂量面积乘积（DAP）、累积剂量（CD）和透视时间（FT）。记录PSD〉2Gy以及PSD〉3Gy的患者频数。以DAP分布第3四分位数作为剂量参考水平（DRL），并和权威机构所发布的DRL进行比较。采用Kruskal Wallis秩和检验比较接受不同介入诊疗方法患者的辐射剂量，采用Spearman方法分析PSD、DAP、CD间的总体相关性。结果接受CAG、PTCA和RF的患者，PSD中位数分别为0．24、1．05、0．62Gy，DAP中位数分别为34．99、94．53、36．33Gy·cm^2，CD中位数分别为0．39、1．27、0．36Gy，FT中位数分别为4．50、15.31、13．40min，差异均有统计学意义（x^2值分别为105．083、92．032、115．509、100．883，P均〈0．01）。总体上DAP和CD、PSD和CD、PSD和DAP间均具有相关性（r值分别为0．845、0．779和0．938，P均〈0．01）。238例中，9．2％（22／238）患者PSD〉2Gy，其中包括行PTCA患者14例、行RF患者8例；1．6％（4／238）患者PSD〉3Gy，其中包括行PTCA患者1例、行RF患者3例。行PTCA患者的DRL为133Gy·cm^2，高于文献的结果（分别为92、94Gy·cm^2）；行CAG患者的DRL为46Gy·cm^2，略低于文献的结果（分别为53．1、57．0Gy·cm^2）；行RF患者的DRL为49Gy·cm^2。结论接受常规心脏介入诊疗的患者中，CAG和RF的剂量水平适中，而PTCA规程中剂量值较高。Objective To investigate patient doses undergoing routine interventional cardiology procedures in China. Methods A retrospective analysis was performed on 238 adult patients who achieved one of interventional procedures including coronary angiography （CAG）, pereutaneous coronary angioplasty （PTCA） and radiofrequency catheter ablation （RF）. According to intervention operations, all cases were divided into three groups： CAG （77）, PTCA （95） and RF （66）. Data of four special metrics, peak skin dose （PSD）, dose-area product （DAP）, cumulative dose （CD）, and fluoroscopy time （FT）, these parameters were measured and collected for these procedures. Frequencies of high-dose cases （PSD〉2 Gy and PSD〉3 Gy） were specifically recorded. Third quartile of DAP distribution was used to establish dose reference level （DRL） and then DRL values in this study were compared with ones reported in literatures. Wallis Kruskal rank-sum test was used to compare radiation dose of patients undergoing different intervention procedures. The total correlation among CD, DAP and PSD was analyzed by Spearman method. Results For patients undergoing CAG,PTCA and RF procedure, the median PSDs were 0.24, 1.05 and 0.62 Gy, respectively.The median DAPs were 34.99, 94.53 and 36.33 Gy· cm^2, respectively.The median CDs were 0.39, 1.27 and 0.36 Gy, respectively.The median FTs were 4.50, 15.31 and 13.40 min, respectively. The difference among procedures was statistically significant （x^2=105.083, 92.032, 115.509, 100.883, respectively, P〈0.01）. For all cases, DAP and CD were correlative （r=0.845, P〈0.01）, also PSD and CD （r=0.779, P〈0.01）, PSD and DAP （r=0.938, P〈0.01）. There were 9.2% （22/238） patients with PSD〉2 Gy, including 14 patients undergoing PTCA and 8 patients undergoing RF. There were 1.6% （22/238） patients with PSD〉3 Gy, including 1 patients undergoing PTCA and 3 patients undergoing RF. The DRL for FFCA in this study is 133 Gy· cm^2 and higher than that in

关 键 词：心脏 放射性 介入性 辐射剂量 对比研究 

分 类 号：R541[医药卫生—心血管疾病] R816.2[医药卫生—内科学]