组合铅屏在电生理介入诊疗中对术者的防护价值  

Application of combined lead screens to protect interventional cardiologist in the electrophysiology labo-ratory

作　　者：孙巍[1] 郑黎晖[1] 姚焰[1] 张奎俊[1] 乔宇[1] 侯炳波[1] 吴灵敏[1] 郭金锐[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2016年第3期202-206,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的： X线透视仍然是目前电生理检查及治疗不可或缺的影像学技术。本研究旨在评估组合悬挂式铅屏和滑轮可移动式铅屏对电生理介入术者的防护价值。方法连续入选2014年12月至2015年6月于阜外医院心律失常中心接受单一术者实施电生理介入治疗的117例患者，在使用防护铅屏和未使用防护铅屏的情况下分别测量右前斜30°、后前位、左前斜30°和左前斜45°投照角度下术者左侧胸部水平的辐射剂量率，同时记录每例患者剂量表面乘积和累及皮肤表面入射剂量。结果使用组合铅屏防护后，右前斜30°、后前位、左前斜30°和左前斜45°投照角度下测得的辐射剂量率分别从（14．8±4．8） mSv／h、（26．9±15．6） mSv／h、（72．7±13．4） mSv／h和（131．4±75．5） mSv／h降低至（0．8±0．7） mSv／h、（2．4±0．7） mSv／h、（2．0±1．3） mSv／h和（2．6±1．6） mSv／h（P＜0．001）。不同体质指数（BMI）亚组中，高BMI组（BMI≥25．0）在未使用组合铅屏防护时在后前位、左前斜30°和左前斜45°投照角度下测得的辐射剂量率均显著高于正常BMI组（BMI＜25．0）患者（P＜0．001），使用组合铅屏防护后两组在各个投照角度下测得的辐射剂量率差异无统计学意义。结论组合铅屏在电生理介入治疗操作中可有效降低电生理介入术者的辐射剂量，是实用的个人防护措施。Objective Fluoroscopy remains an unreplaceable imaging technique in the contemporary electrophysiology era .We evaluated the impact of a combined lead screens ,which is composed of a suspended-typed lead glass screen and a moveable lead screen ,on clinically significant parameters of radiation exposure . Methods One hundred and seventeen patients receiving electrophysiology studies performed by a single expe -rienced interventional cardiologist from December 2014 to june 2015 in Fuwai Hospital were continuously en-rolled.Radiation dose rates in different X ray projections were measured ,including right anterior oblique （RAO） 30°,anterior posterior（AP）,left anterior oblique（LAO）30°and LAO 45°.Measurements of radiation dose rate were repeated in different X ray projections with the protection of combined lead screens .Dose area product （DAP）and cumulative air kerma（CAK）data were automatically computed by the system for each x-ray acquisi-tion.Results Under the protection of the combined lead screens ,radiation dose rates in RAO 30°,AP,LAO 30°and LAO 45°projection were significantly dropped from （ 14.8 ±4.8 ） mSv/h, （ 26.9 ±15.6 ） mSv/h, （72.7±13.4） mSv/h,（131.4±75.5） mSv/h to（0.8±0.7） mSv/h,（2.4±0.7） mSv/h,（2.0±1.3） mSv/h and（2.6±1.6） mSv/h,respectively（P〈0.001）.In the subgroup analysis,radiation dose rate measured of the patients with BMI≥25.0 were statistically higher than that of the patients whose BMI was lower than 25.0 in all the three projection angles（AP,LAO 30°and LAO 45°）.However,this difference of the radiation dose rates in the two groups disappeared after the application of the combined lead screen .Conclusion As a practical and applicable personal protection technique ,the combined lead screens can offer an extra protection against radia-tion exposure for interventional cardiologist during the electrophysiology procedures .

关 键 词：电生理介入治疗 放射暴露 组合铅屏 放射防护 

分 类 号：R816.2[医药卫生—放射医学] R541.7[医药卫生—临床医学]