心血管介入操作中患者受照剂量分析和相关辐射损伤研究

发布时间：2018-07-13 18:59

【摘要】：目的：测量各类心血管介入在诊疗过程中患者所受的X射线辐射剂量，记录透视时间，分析各种介入辐射剂量；调查心血管介入术前及术后患者染色体畸变率和微核率情况，探讨影响辐射剂量的因素及减少辐射损伤的方法，加强辐射防护。方法：1.分析安徽医科大学第一附属医院心血管内科介入手术详细记录442例患者的辐射剂量资料，测量患者的面积剂量乘积DAP值、入射剂量CD值及透视时间，进行参数比较，并比较甲、乙、丙三位术者的患者辐射剂量。2.对心血管介入诊疗的100例住院患者采集外周血，分为术前及术后自身对照。术后记录患者辐射剂量，根据患者所受辐射剂量不同，再分为4组，即低于0.5Gy组，0.5~1.0Gy组，，1.0~2.0Gy组，以及2.0Gy以上组，检测每组患者术前及术后淋巴细胞染色体畸变率和微核率。结果：1.不同心血管病介入操作患者的辐射剂量存在明显差异。先天性心脏病和冠状动脉造影透视时间较短，辐射剂量较小；冠状动脉支架术和射频消融术透视时间较长，辐射剂量较大。各类心血管介入操作中冠状动脉介入术的入射剂量和剂量面积乘积较大，射频消融时间相对较长。术者甲的患者辐射剂量明显低于乙和丙。按照ICRP剂量分类的参考标准，儿童心血管介入术中所受辐射剂量较小，仅2.1%的患儿CD值超过1.0Gy。2.在4组辐射剂量中，术后2h、24h、72h染色体畸变率及微核率与术前相比，㩳0.5Gy组差异无统计学意义，其他三组均有统计学意义（P均㩳0.05），其中2.0Gy组与术前相比明显增多(P㩳0.01)。术后2h、24h、72h4组之间相比较，2.0Gy组染色体畸变率及微核率明显增高（P均㩳0.05）。1.0～2.0Gy组与0.5～1.0Gy组、㩳0.5Gy组比较，染色体畸变率及微核率明显增高（P均㩳0.05）。冠状动脉介入治疗患者术后染色体畸变率及微核率明显增高。部分复杂的房颤射频消融术患者出现染色体畸变和微核。结论：1.影响心血管介入辐射剂量的因素较多，包括病变程度、操作者手术熟练程度、透视时间等。2.心血管介入患者中部分出现染色体畸变微核。患者术后染色体畸变率及微核率随着辐射剂量的增加而升高。3.在心血管介入操作中辐射不可避免。儿童辐射剂量虽偏小，但辐射损伤的敏感性很大。关键是在保证手术质量的前体下，增强操作者的剂量意识，缩短患者的透视时间，减少辐射剂量。
[Abstract]:Objective: to measure the radiation dose of various kinds of cardiovascular intervention in the course of diagnosis and treatment, to record the time of fluoroscopy, to analyze the dose of various kinds of interventional radiation, to investigate the rate of chromosome aberration and micronucleus in patients before and after cardiovascular intervention. The factors affecting radiation dose and the methods to reduce radiation damage are discussed to strengthen radiation protection. Method 1: 1. The radiation dose data of 442 patients were recorded in detail by interventional operation in Department of Cardiovascular Medicine, the first affiliated Hospital of Anhui Medical University. The area dose product DAP value, incident dose CD value and fluoroscopy time were measured, and the parameters were compared and compared. Radiation dose. 2. 2. Peripheral blood was collected from 100 inpatients with cardiovascular intervention and divided into self-control before and after operation. The radiation dose was recorded and divided into 4 groups according to the dose of radiation received by the patients. The patients were divided into 4 groups: lower than 0.5 Gy group, 0.5 ~ 1.0 Gy group, 1.0 ~ 2.0 Gy group, and more than 2.0 Gy group. The chromosome aberration rate and micronucleus rate of lymphocytes in each group were measured before and after operation. The result is 1: 1. There were significant differences in radiation doses among patients with different cardiovascular intervention procedures. The fluoroscopy time of congenital heart disease and coronary arteriography is shorter and the radiation dose is smaller, and the fluoroscopy time of coronary stenting and radiofrequency ablation is longer and the radiation dose is larger. The incidence dose and dose area of coronary intervention are larger and the radiofrequency ablation time is relatively long. The radiation dose of patient A was significantly lower than that of B and C. According to the reference criteria of ICRP dose classification, the radiation dose during cardiovascular intervention in children was relatively small, and only 2.1% of the children had CD values over 1.0 Gy.2. There was no significant difference in chromosome aberration rate and micronucleus rate between 2 hours and 24 hours after operation in the four groups (P < 0.05), but there was no significant difference in the other three groups (P < 0.05). The rate of chromosome aberration and micronucleus in the 2.0Gy group was significantly higher than that in the preoperative group (P0.01). The chromosome aberration rate and micronucleus rate in the 2.0Gy group were significantly higher than those in the 0.5Gy group (P 0.05). The chromosome aberration rate and micronucleus rate were significantly higher in the 1.0Gy group than in the 0.5Gy group (all P 0.05). The rate of chromosome aberration and micronucleus increased significantly after coronary intervention. Chromosomal aberrations and micronuclei are present in patients with partially complex radiofrequency ablation of atrial fibrillation. Conclusion 1. There are many factors influencing the radiation dose of cardiovascular intervention, including the degree of pathological changes, the skill of the operator, the fluoroscopy time, and so on. Some micronuclei of chromosome aberration were found in patients with cardiovascular intervention. The rate of chromosome aberration and micronucleus increased with the increase of radiation dose. Radiation is inevitable in cardiovascular intervention. Although the radiation dose of children is small, but the sensitivity of radiation damage is very large. The key is to enhance the operator's dose awareness, shorten the patient's fluoroscopy time and reduce the radiation dose under the condition of ensuring the quality of surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R144

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