基于CT血管造影的主动脉球囊阻断影像学研究

Imageological study of aorta balloon occlusion based on CT angiography

目的基于主动脉CT血管造影(CTA)探讨主动脉球囊阻断(ABO)相关的影像学特点,为提高体表标志法的成功率提供参考。方法采用回顾性病例系列研究分析2019年4月至2019年12月浙江大学医学院附属第二医院收治的57例接受全长主动脉CTA且主动脉结构正常患者临床资料,其中男40例,女17例;年龄18~70岁[(60.0±9.4)岁]。借助CT工作站,应用多平面重建、曲率平面重建和容积再现等技术进行主动脉三维重建,测量降主动脉及主动脉Ⅰ、Ⅱ、Ⅲ区的长度及各分界处动脉直径、左右两侧股动脉穿刺点至左锁骨下动脉、腹腔干、肾动脉最低处和腹主动脉分叉处的距离、两侧股动脉穿刺点至体表解剖标志的距离。比较左右两侧股动脉穿刺点至胸骨上切迹的距离与至左锁骨下动脉的距离、两侧股动脉穿刺点至剑突的距离与至腹腔干的距离、两侧股动脉穿刺点至剑突的距离与至肾动脉最低处的距离、两侧股动脉穿刺点至脐的距离与至腹主动脉分叉处的距离。结果(1)降主动脉的长度为(37.6±2.8)cm,主动脉Ⅰ、Ⅱ、Ⅲ区的长度分别为(24.7±2.2)cm、(3.4±0.8)cm、(9.4±1.0)cm。左侧锁骨下动脉处的主动脉直径为20.0~36.0 mm[(27.0±3.9)mm],腹腔干直径为3.0~14.0 mm[(8.0±2.2)mm],肾动脉最低处的主动脉直径为10.0~23.0 mm[(16.0±2.4)mm],腹主动脉分叉处直径为10.0~25.0 mm[(15.0±2.4)mm],两侧股动脉直径均为4.0~11.0 mm[(8.0±1.5)mm]。(2)左右两侧股动脉穿刺点至左锁骨下动脉、腹腔干、肾动脉最低处及腹主动脉分叉处的长度分别为50.3~68.2 cm[(56.6±3.9)cm]及50.1~69.5 cm[(57.1±4.0)cm]、26.6~38.2 cm[(31.9±2.4)cm]及27.7~39.6 cm[(32.4±2.4)cm]、22.1~33.1 cm[(28.5±2.2)cm]及23.3~34.2 cm[(29.0±2.2)cm]、13.9~23.8 cm[(19.2±2.0)cm]及15.4~24.1 cm[(19.7±2.1)cm]。(3)左右侧股动脉穿刺点至胸骨上切迹、剑突和脐的直线距离分别为39.7~56.5 cm[(51.0±3.2)cm]及39.8~56.5 cm[(50.8±3.1)cm]、23.0~37.9 cm[(33.2±2.7)cm]及23.2~37.7 cm[(33.0±2.8)cm]、12.2~19.1 cm[(15.9±1.5)cm]及11.6~18.2 cm[(15.5±1.5)cm]。两侧股动脉穿刺点至左锁骨下动脉的距离大于至胸骨上切迹的距离(P<0.05),左侧股动脉穿刺点至腹腔干的长度小于至剑突的距离(P<0.05),右侧差异无统计学意义(〖WTBX〗P〖WTBZ〗>0.05)。两侧股动脉穿刺点至剑突的距离大于至肾动脉最低处的距离,两侧股动脉穿刺点至脐的距离小于股动脉穿刺点至腹主动脉分叉处的距离(P<0.05)。结论主动脉Ⅰ区阻断时ABO的置管深度应尽可能小于股动脉穿刺点至胸骨上切迹的距离,大于穿刺点至剑突的距离;Ⅲ区阻断时尽可能小于穿刺点至剑突的距离,大于穿刺点至脐的距离。体表标志法可在紧急情况下指导ABO快速有效的应用。

Objective To explore the imaging characteristics of aortic balloon occlusion(ABO)based on aortic computed tomography angiography(CTA),so as to provide references for improving the success rate of body surface marker approach.Methods A retrospective case series study was conducted to analyze the clinical data of 57 patients who underwent full-length aortic CTA with normal aorta in Second Affiliated Hospital of Medical College of Zhejiang University from April 2019 to December 2019.There were 40 males and 17 females,with the age of 18-70 years[(60.0±9.4)years].With the help of CT workstation,multi-plane reconstniction,curvature plane reconstruction and volume reconstruction were used to reconstmct the aorta.The length of the descending aorta and the aortic zones,diameter of the arteries at each boundary of the aorta,distance from the bilateral femoral artery puncture point to left subclavian artery,celiac trunk,lowest renal artery,aortic bifurcation,and distance from bilateral femoral cilleries puncture point to the anatomic landmarks on the body surface were measured.The distance from bilateral femoral artery puncture point to the supraclavicular notch and the distance to the left subclavian artery,the distance from bilateral femoral artery puncture point to the xiphoid process and the distance to celiac trunk,the distance from bilateral femoral artery puncture point to the xiphoid process and the distance to lowest renal artery,the distance from bilateral femoral artery puncture point to the umbilicus and the distance to the aortic bifurcation were compared.Results(1)The length of the descending aorta was(37.6±2.8)cm,and the length of zone Ⅰ,Ⅱ and Ⅲ were(24.7±2.2)cm,(3.4±0.8)cm,(9.4±1.0)cm respectively.The diameter of the aorta at the left subclavian artery,celiac trunk,lowest renal artery,aortic bifurcation,and bilateral femoral arteries were 20.0-36.0 mm[(27.0±3.9)mm],3.0-14.0 mm[(8.0±2.2)mm],10.0-23.0 mm[(16.0±2.4)mm],10.0-25.0 mm[(15.0±2.4)mm],4.0-11.0 mm[(8.0±1.5)mm]respectively.(2)The distances from left and right femoral artery puncture point to the left subclavian artery,celiac trunk,lowest renal artery and aortic bifurcation were 50.3-68.2 cm[(56.6±3.9)cm]and 50.1-69.5 cm[(57.1±4.0)cm],26.6-38.2 cm[(31.9±2.4)cm]and 27.7-39.6 cm[(32.4±2.4)cm],22.1-33.1 cm[(28.5±2.2)cm]and 23.3-34.2 cm[(29.0±2.2)cm],13.9-23.8 cm[(19.2±2.0)cm]and 15.4-24.1 cm[(19.7±2.1)cm]respectively.(3)The linear distances from left and right femoral artery puncture point to the suprasternal notch,xiphoid process and umbilicus were 39.7-56.5 cm[(51.0±3.2)cm]and 39.8-56.5 cm[(50.8±3.1)cm],23.0-37.9 cm[(33.2±2.7)cm]and 23.2-37.7 cm[(33.0±2.8)cm],12.2-19.1 cm[(15.9±1.5)cm]and 11.6-18.2 cm[(15.5±1.5)cm]respectivety.The length from the bilateral femoral artery to the left subclavian artery was larger than that to the suprastenial notch(P vO.05).The length from the left femoral artery to the celiac tnink was smaller than that to the xiphoid process(P<0.05),but there was no statistical significance on the right side(P>0.05).The distance from the bilateral femoral artery to the xiphoid process was larger than that to the lowest renal artery,and the distance from the bilateral femoral artery to the umbilicus was smaller than that to the aortic bifurcation(P<0.05).Conclusions The depth of catheterization in zone I should be between the suprasternal notch and the xiphoid process and the depth of catheterization in zone Ⅲ is between the xiphoid process and the umbilicus.The body surface marker approach can guide the rapid and effective application of ABO in emergency.