目的 比较经桡动脉与经股动脉途径行冠脉造影术中患者及术者的辐射剂量。方法 采用同一拟人体模模拟临床条件下的冠脉造影。根据不同造影入路(均为右侧入路),实验分为经股动脉行冠脉造影组(transfemoral intervention ,TFI)和经桡动脉行冠脉造影组(transradial intervention,TRI),根据不同测量位置和不同辐射防护措施,TFI组进一步分为TFI1-TFI4四个亚组,TRI组进一步分为TRI1-TRI8八个亚组。使用皮肤辐射剂量仪和造影机随机配备的射线剂量仪(DAP和AK)分别记录术者和患者的辐射剂量,使用机器预设程序自动调节造影体位并控制透视及造影时间,每组数据重复测量10次取均值进行比较。结果 TRI组总剂量均值、透视累计剂量均值、造影累计剂量均值较TFI组均明显增加。造影过程7个体位中,DAP、AK值最大的三个体位均为左前斜体位。经桡动脉操作时,使用桡动脉专用护具的各亚组,其术者的辐射剂量均明显低于未使用护具的亚组。结论 与TFI相比,TRI时术者手部、胸部辐射剂量明显高于前者,而胸部辐射剂量的差异在左前斜体位时最为显著,其他体位并不明显;无论何种入路行冠脉造影,患者辐射剂量在左前斜体位时最高。因此术者在操作过程中应该合理使用造影体位,减少不必要的辐射。桡动脉专用护具配合常规防护设备共同使用可以大大减少经桡动脉操作时术者辐射剂量,值得推广。
Abstract
Objective To compare radiation doses of patients and operators between transfemoral and transradial coronary angiography.Methods A phantom was used to simulate coronary angiography under clinical conditions. According to different accesses, our experiment was divided into the TFI group (transfemoral intervention)and the TRI group (transradial intervention).According to different gauge positions and radiation protection measures,the TFI group was divided into subgroups TFI1-TFI4 while the TRI group was divided into subgroups TRI1-TRI8.The radiation doses of patients and operators were recorded with the same thermoluminescent dosimeter and the X-ray dosimeter equipped in the angiography machine.The angiography positions were switched while the fluoroscopy and cine time were controlled by using preset programs in the machine.The measurement of each group was pepeated 10 times before the mean values were compared.Results Compared with the TFI group,the mean values of the aggregate dose,cumulative dose of fluoroscopy and angiography in the TRI group increased significantly.Among the 7 positions of coronary angiography,the maximal values of DAP and AK were related to LAO position.When operating with the radial artery access ,the operators'radiation dose in the subgroups with the protection of exclusive use of radial artery was reduced obviously compared with subgroups without the protection.Conclusions Compared with transfemoral coronary angiography,the radiation dose of operator’s hands and chests is significantly higher in transradial coronary angiography.The difference of operator’s chests is much more remarkable in the LAO positions than in other positions.Whatever the access ,the radiation dose of patients is highest in the LAO positions.Therefore ,operators should choose the right position in the course of operation to reduce unnecessary radiation.The combined use of special radiak artery protective equipment and conventional protective equipments can greatly reduce the radiation dose of operators undergoing transradial operation,which is worth of popularization.
关键词
桡动脉 /
股动脉 /
辐射剂量 /
防护 /
体位效应
Key words
radial aretry /
femoral aretry /
radiation dose /
protection /
position effects
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