急性缺血性脑卒中患者介入治疗时所受的辐射剂量的影响因素

Radiation dose in patients with acute ischemic stroke

目的分析急性缺血性脑卒中患者在介入诊疗中的受照剂量,探讨性别、年龄、病变部位以及诊疗方式等因素对辐射剂量的影响。方法回顾性分析我院行介入治疗的急性缺血性脑卒中患者156例,最终纳入113例,随机配置的辐射监测系统记录透视时间(FT)、剂量面积乘积(DAP)、空气比释动能(AK)。分析性别、患者年龄(30~60岁组、60~80岁组、≥80岁组)、闭塞位置(前、后循环)以及血管开通技术对患者受照剂量的影响。结果患者FT值7.94~97.41 min(24.0±14.4 min);DAP值1638~551959 mGy·cm2(137422.8±107778.1 mGy·cm2);AK值11~5726 mGy(1210.9±1070.8 mGy)。男性患者辐射剂量高于女性患者,DAP值、AK值差异有统计学意义(P<0.05);3个年龄组间各剂量值差异均无统计学意义(P>0.05);前、后循环闭塞患者所受剂量差异无统计学意义(P>0.05);单纯导管抽吸(ASPI)患者辐射剂量最低,导管抽吸结合支架取栓(ASPI+SR)以及支架植入术组的辐射剂量大于ASPI组,3个剂量值差异均有统计学意义(P<0.05)。结论急性缺血性脑卒中患者所受辐射剂量差异较大,性别、血管开通方式均是影响辐射剂量的重要因素。因此,可能需要针对不同特征的患者采取更积极的防护措施。

Objective To analyze the dose of radiation in patients with acute ischemic stroke and to explore the influence of gender,age,lesion location and diagnosis and treatment methods on radiation dose.Methods A total of 156 patients with acute ischemic stroke who underwent interventional therapy in our hospital were retrospectively analyzed,and 113 cases were finally included.Fluoroscopy time(FT),dose area product(DAP)and air specific kinetic energy(AK)were recorded by a random radiation monitoring system.The effects of gender,age(30-60 years old group,60-80 years old group and≥80 years old group),occlusion position(anterior and posterior circulation)and vascular opening technology on radiation dose were analyzed.Results The FT value of the patients ranged from 7.94 to 97.41 min,with an average value of 24.0±14.4 min.The DAP value of the dose area ranged from 1638 to 551959 mGy·cm2,the average was 137422.8±107778.1 mGy·cm2.The AK value of the dose area ranged from 11 to 5726 mGy,the average was 1210.9±1070.8 mGy.Compared with males,females had less radiation dose.The values of DAP and AK had significant difference(P<0.05).There was no significant difference between the three age groups in the analysis of the variance of each dose(P>0.05).There was no significant difference in the dose received by patients with anterior and posterior circulation occlusion(P>0.05).Patients with single catheter aspiration(ASPI)had the lowest radiation dose.The radiation dose of the catheter aspiration combined with stent retriever(ASPI+SR)and the stent implantation group was larger than that of the catheter aspiration only,and the difference of the three dose values was statistically significant(P<0.05).Conclusion The radiation dose of patients with acute ischemic stroke varies greatly,and gender,the way of vascular opening are all important factors affecting the radiation dose.Therefore,more aggressive protective measures may be needed for patients with different characteristics.