冠心病介入诊治中患者的X射线辐射评估

The Evaluation of X-Ray Radiation for Coronary Heart Disease Patients in Interventional Process

为探讨在对冠心病进行经皮冠状动脉动脉介入诊治过程中患者所受X线辐射的强度。对 112例冠心病患者 (5 3例冠状动脉左心室造影和 5 9例冠状动脉内支架植入治疗 )采用随DSA机配置的穿透电离室型剂量监测系统 ,测得剂量面积乘积和皮肤入射剂量 ,用Monte Carlo转换系数从剂量面积乘积估算有效剂量。 112例患者进行经皮冠状动脉动脉介入诊治过程中的剂量面积乘积、皮肤入射剂量和有效剂量均值分别为 5 9.1± 5 1.5Gycm2 、6 2 6± 5 90mGy和 8.3± 7.2mSv;其中冠状动脉内支架植入治疗过程中的剂量值分别为 83.5± 5 7.6Gycm2 、92 6± 6 5 6mGy和 11.7± 8.1mSv ,冠状动脉左心室造影过程中的剂量值分别为 31.9± 2 1.5Gycm2 、2 92± 2 18mGy和 4 .5± 3.0mSv ,两组间各剂量值都有非常显著性差异 (P <0 .0 1)。冠状动脉内支架植入治疗组透视剂量对总剂量的贡献 (剂量面积乘积为 6 1.6 %± 12 .9% ,皮肤入射剂量为 6 2 .1%± 14 .2 % )明显大于冠状动脉左心室造影组 (剂量面积乘积为4 7.8%± 13.9% ,皮肤入射剂量为 4 4 .2 %± 16 .1% ) ;而摄影剂量对总剂量的贡献 (剂量面积乘积为 38.5 %± 12 .9% ,皮肤入射剂量为 37.5 %± 13.6 % )明显小于冠状动脉左心室造影组 (剂量面积乘积为 5 2 .0 %± 13.7% ,皮肤?

Aim To investigate the X-ray radiation of coronary heart disease patients rooted in coronary and left ventrical cinematography (CALVC) and intra-coronary stent implantation (ICSI). Methods 112 CHD cases were analysed, including 53 patients with CALVC, and 59 with ICSI. The radiation dose values,such as DAP (dose-area product) and ESD (enter skin dose) measured by using a dose system equipped in Angiostar-Plus, were obtained. Effect dose (ED) was estimated by Monte-Carlo conversion coefficient from the DAP. Results The dose values of DAP, ESD and ED in this serial measured respectively for 59.1±51.5 Gycm 2, 626±590 mGy, 8.3±7.2 mSv; in ICSI group for 83.5±57.6 Gycm 2, 926±656 mGy, 11.7±8.1 mSv; and in CALVC group was 31.9±21.5 Gycm 2, 292±218 mGy, 4.5±3.0 mSv, respectively. The fluoroscopy in ICSI contributed to total exposure dose (DAP: 61.6%±12.9%, ESD: 62.1%±14.2%) were larger than in CALVC (DAP: 47.8%±13.9%, ESD: 44.2%±16.1%); and the contribution of photography for total radiation dose in CALVC (DAP: 52.0%±13.7%, ESD: 58.3%±27.9%) were obviously preponderate over ICSI group (DAP: 38.5%±12.9%, ESD: 37.5%±13.6%). There were statistical difference of dose between ICSI and CALVC (P<0.01), and so do the dose contribution of fluoroscopy or radiography. Conclusion The CHDs patients got higher radiation exposure during a PCI process, radiation dose of treatment mode was evidently higher than that of diagnostic radiography. The main influence on total dose in CALVC was radiography, while in ICSI was fluoroscopy.