94例儿童先心病介入手术辐射剂量及影响因素分析  

Analysis of radiation dose and influencing factors during interventional procedures for 94 patients with pediatric congenital heart disease

作　　者：商玉秀 杨显存 马娅[1] 王小山 陈英民[1] SHANG Yuxiu;YANG Xiancun;MA Ya;WANG Xiaoshan;CHEN Yingmin(Institute of Radiation Medicine of Shandong Academy of Medical Sciences,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250117 China;Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021 China)

机构地区：[1]山东省医学科学院放射医学研究所,山东第一医科大学(山东省医学科学院),山东济南250117 [2]山东第一医科大学(山东省医学科学院)附属省立医院,山东济南250021

出　　处：《中国辐射卫生》2023年第6期673-678,共6页Chinese Journal of Radiological Health

基　　金：山东省自然科学基金(ZR2021MH053);山东第一医科大学(山东省医学科学院)青年科学基金培育资助计划(202201-001);山东省医药卫生科技发展计划(202012070680)。

摘　　要：目的 评估儿童先心病介入手术的辐射剂量,分析差异性和影响辐射剂量的相关因素。方法 将94例2021年6月—2022年9月在山东省济南市某三甲医院接受先心病介入手术的患儿,按手术类型分为3组,包括室间隔缺损封堵术组(VSD组)48例、动脉导管未闭封堵术组(PDA组)29例、房间隔缺损封堵术组(ASD组)17例。记录患者基本资料、术后剂量报告,应用SPSS软件进行统计分析。结果 VSD组、PDA组、ASD组的累积剂量(CAK)中位数分别为100.5 mGy、43.7 mGy、12.1 mGy,剂量面积乘积(KAP)中位数分别为3.309 Gy·cm^(2)、1.313 Gy·cm^(2)、0.540 Gy·cm^(2),KAP·kg^(-1)中位数分别达到了0.179 Gy·cm^(2)·kg^(-1)、0.088 Gy·cm^(2)·kg^(-1)、0.031 Gy·cm^(2)·kg^(-1),3种介入手术的透视时间、减影图像数(CI)、CAK值、KAP值和KAP·kg^(-1)差异有统计学意义(P<0.05),且VSD组的透视时间、CI、CAK值、KAP值、KAP·kg^(-1)均显著高于PDA组和ASD组(P<0.05)。多元线性回归分析发现年龄(B=52.445,P<0.05)、体重(B=13.077,P<0.05)、透视时间(B=0.425,P<0.05)、管电流(B=0.872,P<0.05)、减影图像数(B=0.660,P<0.05)与KAP值呈正相关,身高和KAP值之间无统计学意义(P>0.05);结论 3种手术的辐射剂量存在差异性,在满足手术需求的前提下减少透视时间、管电流和减影图像数,对降低患儿所受辐射剂量具有重要意义。Objective To evaluate the radiation dose of interventional procedure for children with congenital heart disease,and to analyze the differences in radiation dose and influencing factors.Methods A total of 94 children who underwent interventional procedure for congenital heart disease at a grade A tertiary hospital in Jinan,Shandong Province,China from June 2021 to September 2022 were included in this study.The patients were divided into three groups according to the type of procedure:ventricular septal defect occlusion group(VSD,48 cases),patent ductus arteriosus occlusion group(PDA,29 cases),and atrial septal defect occlusion group(ASD,17 cases).The basic information of patients and postoperative dose reports were recorded.A statistical analysis was performed using SPSS software.Results The median cumulative air kerma(CAK)of VSD,PDA,and ASD was 100.5,43.7,and 12.1 mGy,respectively.The median air kerma area product(KAP)of VSD,PDA,and ASD was 3.309,1.313,and 0.540 Gy·cm^(2),respectively.The median KAP·kg^(-1) of VSD,PDA,and ASD was 0.179,0.088,and 0.031 Gy·cm^(2)·kg^(-1),respectively.There were significant differences in fluoroscopy time,number of cine images,CAK,KAP,and KAP·kg^(-1) among the three types of interventional procedures(P<0.05).Compared with PDA and ASD,VSD showed significantly higher fluoroscopy time,number of cine images,CAK,KAP,and KAP·kg^(-1)(P<0.05).Multiple linear regression analysis found that age(B=52.445,P<0.05),weight(B=13.077,P<0.05),fluoroscopy time(B=0.425,P<0.05),tube current(B=0.872,P<0.05),and number of cine images(B=0.660,P<0.05)were positively correlated with KAP,while there was no significant association between height and KAP(P>0.05)Conclusion There are differences in radiation dose among the three types of procedures.Reducing fluoroscopy time,tube current,and number of cine images while meeting the procedure requirements is of great significance for reducing the radiation dose received by children.

关 键 词：儿童 先心病 介入手术 辐射剂量 CAK KAP 

分 类 号：X591[环境科学与工程—环境工程]