冠状动脉CT血管成像中个体化心率控制技术的临床应用研究

发布时间：2018-04-24 01:29

  本文选题：冠状动脉 + X线计算机体层摄影术　； 参考：《苏州大学》2012年硕士论文

【摘要】：目的：分析采用个体化心率控制技术后对于指导冠状动脉CT血管成像是否有效，并讨论其价值，为实施个体化辐射剂量管理提供依据。 资料和方法：本课题为回顾性研究。选取909例CCTA检查患者，将前360例列为第一阶段，将后549例列为第二阶段；每个阶段根据患者基础心率分为5个亚组。两个阶段分别采用不同的心率控制技术。（1）分别比较两个阶段中不同亚组的基础HR、基础HRV、服药总量、到达心率稳定期时间、预测HR、预测HRV、扫描HR、扫描HRV，计算预测HR、预测HRV的下降程度，并分析两个阶段中预测HR与扫描HR的相关性；（2）分析第二阶段中预测HR、HRV与各扫描阶段中HR、HRV的变化趋势；（3）计算第二阶段中预测HR、HRV的准确度；（4）比较第二阶段中患者采用个体化心率控制技术后CCTA扫描的有效剂量（ED）及模拟有效剂量，评价三种不同扫描模式下的图像质量。 结果：（1）两个阶段各组患者的基础HR、基础HRV差异均无统计学意义（P0.05）。（2）除55bpm组外，第二阶段的倍他乐克给药量明显高于第一阶段（P0.05）。（3）患者平均到达心率稳定期时间为5.8秒，最短为4秒，最长为9秒。（4）第一阶段HR≥55bpm及第二阶段所有患者的预测HR均低于基础HR（P0.05），与基础HR相比，第一阶段预测HR总体下降12.4%，第二阶段预测HR总体下降15.1%；第一阶段HR≤84bpm组及第二阶段所有患者预测HRV均低于基础HRV（P0.05），与基础HRV相比，第一阶段预测HRV总体下降30.1%，第二阶段预测HRV总体下降52.1%。（5）预测HR与扫描HR相关系数:第一阶段r=0.646，第二阶段r=0.574。（6）第二阶段HR于正位标绘图阶段时明显升高随之下降，HRV于TESTBLOUS阶段时明显升高。（7）以扫描HR为基准，第二阶段预测HR与扫描HR在±5bpm者461例（84.0%），以扫描HRV为基准，预测HRV与扫描HRV在±5bpm者532例（96.9%）。（8）采用个体化心率控制技术后理论上可降低CCTA检查有效剂量22.5%。（9）采用单扇区点期相扫描患者图像质量评分1.52±0.83，单扇区半期相扫描1.62±0.90，二者无显著性差异（P0.05），均高于双扇区半期相扫描3.75±0.89（P0.05）。 结论：采用个体化心率控制技术可以有效降低心率及心率变异度，，并且能够很好的预测患者扫描心率及心率变异度，同时提高单扇区点期相扫描的成功率，保证优质的图像质量，并有效降低辐射剂量。
[Abstract]:Objective: to analyze the effectiveness of individualized heart rate control technique in guiding coronary artery CT angiography and discuss its value in order to provide basis for individualized radiation dose management. Data and methods: this subject is a retrospective study. 909 patients with CCTA were selected, the first 360 patients were selected as the first stage and the latter 549 patients as the second stage, each stage was divided into 5 subgroups according to the patients' basic heart rate. In the two stages, different heart rate control techniques were used to compare the basic HRs, the basic HRVs, the total amount of medication, and the time to reach the stable heart rate in different subgroups of the two stages. Predict HRV, predict HRV, scan HRV, scan HRV, calculate predicted HRR, predict the degree of HRV decline, And analyze the correlation between HR-predicted HR-scan HR in the two phases and the correlation between HR-HRV prediction in the second stage and HR-HRV in each scanning stage. The accuracy of predicting HRV in the second stage is compared with that in the second stage. The accuracy of HRV prediction in the second stage is compared with that in the second stage. The effective dose of CCTA scan and the simulated effective dose after individualized heart rate control, To evaluate the image quality of three different scanning modes. Results (1) there was no significant difference in basic HRV and basal HRV between the two groups. Except for the 55bpm group, the dosage of betaloc in the second stage was significantly higher than that in the first stage (P 0.05). The average time to the stable period of heart rate was 5.8 seconds, and the shortest was 4 seconds. In the first stage, the HR 鈮

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