Stanford B型主动脉夹层旋转血管造影中对比剂注射方案改良研究

Application of optimized contrast media injection protocol for rotational angiography for Stanford type B aortic dissection

目的探讨两种碘对比剂注射方案对Stanford B型主动脉夹层(aortic dissection,AD)旋转血管造影图像质量的影响。方法回顾性分析广东省人民医院2012年1月至2013年7月60例Stanford B型AD患者的主动脉旋转血管造影图像资料,对比剂注射方案分别为生产商推荐方案及改良方案。主观评分指标按5分法评分标准(5分-图像极为满意,4分-图像很好,3分-图像可以满足术中诊断需求,2分-部分细节难以显示,1分-不能诊断)进行评估,包括夹层累及范围、破口大小及位置、头臂干、左侧颈总动脉、左侧锁骨下动脉显示情况。对图像主观评分结果采用两独立样本秩和检验进行比较。结果 60例Stanford B型AD患者中,30例患者使用推荐方案,主观评分为(4.4±0.6)分;30例患者使用改良方案,主观评分为(3.9±1.5)分,两种不同碘对比剂注射方案在旋转造影主观图像质量上比较,差异无统计学意义(P>0.05)。结论碘对比剂注射改良方案与推荐方案在主动脉旋转血管造影对AD的细节诊断方面没有明显差别,可根据临床需要选择改良方案进行检查,以减少对比剂的用量及相应毒副作用。

Objectives To explore the effects of two contrast media injection protocols on the image quality of rotational angiography for Stanford type B aortic dissection.Methods From January 2012 to July 2013,clinical data of 60 patients with aortic dissection （Stanford type B） undergoing rotational angiography in Guangdong General Hospital were reviewed and analyzed.Two contrast media injection protocols （recommended protocol and optimized protocol） were used in these patients.A five-grade scoring system （5,excellent; 4,good; 3,fair; 2,insufficient for complete evaluation; 1,not interpretable） was used in the objective image quality evaluation,including region of aortic dissection,size and location of laceration,brachiocephalic trunk,left common carotid artery and left subclavian artery.Results Of the 60 patients with Stanford type B aortic dissection,recommended protocol was applied in 30 patients （average score：4.4± 0.6）,optimized protocol in 30 patients （average score：3.9± 1.5）.The difference in image quality between recommended protocol and optimized protocol for rotational angiography for aortic dissection was not statistically significant （P＞0.05）.Conclusions There is no obviously difference in image quality between recommended protocol and optimized protocol for rotational angiography for aortic dissection.Therefore,we can choose one of them in rotational angiography for aortic dissection according to the clinical status of patients,in order to reduce the side effects.