移动DR床旁胸片对左心室辅助装置植入术后泵角度评估的可行性探讨  

A preliminary study on the feasibility of mobile DR bedside chest film in evaluating the pump angle after the left ventricular assist device implantation

作　　者：李丽丽[1] 汤加 房品言 刘军波 范丽娟 LI Li-li;TANG Jia;FANG Pin-yan(Department of Radiology,Teda International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]天津大学/泰达国际心血管病医院放射科,天津300457

出　　处：《放射学实践》2024年第5期629-633,共5页Radiologic Practice

基　　金：国家重点研发项目(项目名称:植入式人工心脏及心室辅助装置,项目编号:2017YFC0111000)。

摘　　要：目的:探讨移动DR床旁胸片对左心室辅助装置植入术后泵角度评估的可行性。方法:回顾性搜集自2019年3月我院开展第三代连续流左心室辅助装置植入术临床实验以来,接受手术的患者共24例。根据全国放射科QA/QC学术研讨会纪要标准对所有患者术后当天、ICU期间连续拍摄的每张床旁胸片进行图像质量评级,测量等级为优的床旁胸片以及转出ICU后第1张心脏远达片的辅助装置流入管冠状角,以流入管冠状角作为泵角度的评估指标,比较术后当天与ICU最后1天测量结果的一致性,并评估观察者间测量结果的可重复性。比较ICU最后1天床旁胸片与心脏远达片流入管冠状角测量结果的一致性,并分析术后当天床旁胸片流入管冠状角与患者基线特征包括年龄、身高、体重、体表面积、体质量指数及术前左心室射血分数、左心室舒张末期横径、胸廓横径、术前心胸比率的相关性。结果:24例患者术后当天与ICU最后1天的冠状角[分别为(31.8±24.7)°和(30.0±24.6)°]差异无统计学意义(t=1.21,P>0.05);观察者间可重复性好(术后当天冠状角ICC=0.999,P<0.01;ICU最后一天冠状角ICC=0.997,P<0.01)。连续测量的冠状角大小变化主要受心影大小变化及投照体位的影响。ICU最后1天与心脏远达片冠状角[(32.1±26.2)°]差异无统计学意义(t=1.26,P>0.05)。冠状角仅与患者体重及体质量指数有弱的负相关性(r=-0.442、-0.554,P值均<0.05)。结论:24例患者ICU期间泵角度未发生明显变化,并且左心室辅助装置植入术后使用移动DR床旁胸片对泵角度进行评估是可行的,可以为泵角度的随访提供可靠的基础和依据;较低的体重及体质量指数可能与较宽的冠状角度有关。Objective:To investigate the feasibility of bedside chest film using a mobile digital radiography(DR)system for assessing the pump angle following left ventricular assist device implantation.Methods:Since March 2019,the third-generation continuous flow left ventricular assist device(LVAD)implantation clinical trial has been carried out in our hospital.A total of 24 patients who underwent this operation were retrospectively collected.The image quality of each bedside chest film was graded according to the summary standards of the National Radiology QA/QC symposium.The cannula coronal angles were measured on bedside chest films with excellent image quality and on the first cardiac remote film after ICU transfer.The cannula coronal angle is used as the evaluation index of the pump angle.The consistency between the measurements obtained on the postoperative first day and on the last day in the ICU was compared,and the repeatability of measurements between observers was evaluated.The cannula coronal angles measured on the bedside chest films were compared with those on the first cardiac remote film after ICU transfer.Furthermore,the potential correlations between the coronal angles on the bedside chest films on the postoperative first day and the baseline characteristics of the patients including age,height,weight,body surface area,body mass index,preoperative left ventricular ejection fraction,left ventricular end-diastolic transverse diameter,thoracic transverse diameter,and preoperative cardiothoracic ratio were analyzed.Results:On the postoperative first day and the last day of ICU,the coronal angle was(31.8±24.7)°and(30.0±24.6)°,respectively,with no significant difference(t=1.21,P>0.05).Good repeatability among observers were observed(ICC=0.999,P<0.01;ICC=0.997,P<0.01).The coronal angle was primarily influenced by the cardiac shadow size and the position of projection.No significant difference between the coronal angle measured on the last day of ICU and that measured on the cardiac remote film[(30.0±24.6)°

关 键 词：左心室辅助装置 床旁胸片 冠状角 泵角度 

分 类 号：R541.6[医药卫生—心血管疾病] R814.4[医药卫生—内科学]