动脉导管未闭与肺动脉狭窄介入诊疗中的辐射剂量分析

Radiation dose in interventional therapy of patent ductus arteriosus and pulmonary stenosis

目的了解小儿先天性心脏病（先心病）介入诊疗中受检者的辐射剂量,以便有效开展和加强受检者医疗照射的防护,降低受检者的辐射剂量。方法158例介入治疗患儿,其中男性77例,女性81例;年龄3个月～13岁,平均年龄4岁;体质量5.7～42.0 kg,平均体质量14.2 kg。动脉导管未闭（PDA）封堵术118例,肺动脉狭窄（PS）球囊扩张术40例。采用数字减影血管造影,电影采集模式为小儿心血管模式（ped CARD）;帧频控制30 f/s;透视模式为脉冲控制,4 f/s;根据年龄不同选择管电压在60～70 kV,管电流自动调节;对比剂为非离子型370 mgI/mL碘普罗胺。回顾性分析不同术式、不同年龄患儿进行透视时间、皮肤辐射剂量。结果PDA透视时间（4.66±3.59）min,PS（5.62±2.79）min,两种手术透视时间差异无统计学意义（P〉0.05）;但在同一种手术中透视时间差异较大。皮肤辐射剂量范围1.20~107.00 mGy,平均皮肤辐射剂量22.45 mGy;PDA患儿诊疗时,透视＋电影采集总皮肤辐射剂量为（20.24±13.52）mGy;PS患儿诊疗时,透视＋电影采集总皮肤辐射剂量为（41.88±29.24）mGy;两组患儿皮肤辐射剂量比较,差异有统计学意义（P〈0.05）。不同年龄的皮肤辐射剂量比较,差异有统计学意义（P〈0.05）;不同体质量的皮肤辐射剂量比较,差异有统计学意义（P〈0.05）。结论不同种类手术透视时间的长短与年龄、体质量关系不大,造成透视时间差异显著的主要原因是患儿病变的部位、性质、形态、大小及手术操作者的操作技术和防护意识,要降低辐射剂量,就要缩短透视时间,提高手术操作者的操作技术和防护意识是至关重要。

Objective To improve the awareness of medical radiation and reduce the medical radiation injury,and investigate the radiation dose in interventional therapy of pediatric congenital cardiopathy.Methods A total of 158 children with interventional therapy were enrolled,included 77 males and 81 females.Patients＇ mean age was 4 years old（range 3 months-13 years old）,and mean body weight was 14.2 kg（range 5.7-42.0 kg）.The 118 cases were performed patent ductus arteriosus（PDA） occlusion,and 40 were performed pulmonary stenosis（PS） ballon dilatation.The digital subtraction angiography was adopted,and film acquisition mode was pediatric cardiovascular mode（ped CARD）,the frame rate control was 30 f/s,fluoroscopy mode was pulse control,4 f/s,the tube voltage was 60-70 kV for various ages,tube current was automatically adjusted,and contrast agent was non-ionic Iopromide 370 mgI/mL.The results were statistically analyzed using SPSS 14.0 software.Results The fluoroscopy time of PDA was（4.66 ± 3.59） minutes,and PS was（5.62 ± 2.79） minutes.There were no significant differences in different types of surgery（P 0.05）,but for individual who treated with the same surgery,the differences of fluoroscopy time were significant.The dose of skin was 1.20-107.00 mGy,mean dose of skin was 22.45 mGy.The total radiation dose of skin for fluoroscopy ＋ film were（20.24 ± 13.52） mGy in PDA children,and（41.88 ± 29.24） mGy in PS children（P 0.05） respective.There were significant differences between different age groups（χ2 = 9.15,P 0.05） and different body weight groups（χ2 = 14.36,P 0.05）.Conclusion It is demonstrated that the site,size of lesion and operator protection awareness and technique are the key factors to reduce the radiation dose.