经桡动脉和经股动脉途径经皮冠状动脉介入治疗的术者外照射剂量评价

Comparison of operator radiation exposure during percutaneous coronary intervention via transradial and transfemoral approach

目的 观察经桡动脉途径与经股动脉途径经皮冠状动脉介入治疗（PCI）手术中术者身体各部位的剂量当量情况.方法 入选2012年4月至2013年10月期间接受PCI治疗的患者195例,其中31例采用经股动脉途径（TFA组）,164例采用经桡动脉途径（TRA组）,记录手术时间、曝光时间、剂量-面积乘积（DAP）和2名术者身体各部位的剂量当量.结果 两组患者基线资料均衡.TRA组手术时间长于TFA组[（47.01±15.88）min比（40.56±t13.18）min,P=0.035],差异有统计学意义;两组间曝光时间和DAP指标差异无统计学意义;TRA组左腕关节剂量当量为（0.41±0.11）μSv,高于TFA组的（0.37±0.09）μSv,两组间差异有统计学意义.术者左颞部剂量当量远高于右颞部.结论 术者身体左侧接受了更高剂量的电离辐射,尤其是在TRA组术者左腕关节部位更为显著.应该重视PCI手术的辐射安全,进行有效的放射防护,以降低术者敏感部位的剂量当量.

Objective To investigate the operator radiation exposure during percutaneous coronary intervention via transradial access and the traditional approach of transfemoral access.Methods In this study,we evaluated 195 patients who underwent percutaneous coronary intervention（PCI） by two operators from April 2012 to October 2013.The outcomes of interest were dose area product （DAP） and effective dose equivalent absorbed by operators of all the procedures,comparing transradial approach （TRA）（n=164） and transfemoral approach（TFA） （n=31）.Results Over all,the baseline characteristics of TFA vs TRA groups were comparable.Procedure time was significantly longer during TRA procedures [（47.01 ±15.88）min vs （40.56±13.18）min,respectively,P=0.035],however,Fluoroscopy time and DAP were similar between the two groups.Effective dose equivalent of the operator＇s left wrist was significantly higher among TRA group as compared with those in the TFA group [（0.41±0.11）μSv vs （0.37±0.09）μSv,respectively,P=0.044],and it was the left side of the head which was exposed about three times higher than the right side.Conclusion The left side of the whole body on the operator have high radiation exposure during percutaneous coronary intervention procedure in both groups,and it was even more significant at the left wrist in TRA group.Major awareness of radiation safety and training in radiological protection are essential and imperative.