超声测量误差对房间隔缺损介入治疗辐射剂量的影响

摘要

目的 探讨经胸超声心动图(TTE)测量房间隔缺损(ASD)破口直径误差对介入治疗辐射剂量的影响.方法 回顾本院79例ASD介入治疗患者,根据TTE测量ASD破口直径选择封堵器的次数分为A、B、C3组,即只需1次封堵成功者为A组(50例),2次封堵成功者为B组(22例),3次封堵成功者为C组(7例).记录3组患者:①TTE的测量值、封堵器尺寸及更换次数;②辐射剂量[累积辐射剂量(AK,Gy)、面积剂量乘积(DAP,Gy·cm2)、透视时间(T,min)];③性别、年龄及体质量.结果 3组ASD患者通过不同封堵次数均成功,TTE和封堵器的符合率分别为62.67％、28％0、9.33％;但辐射剂量AK、DAP及T差异均有统计学意义(FAK=12.119,P=0.000;FDAP =8.241,P=0.001;FT=12.777,P=0.000),C组T和辐射剂量最大,A组最小,B组介于A、C组之间;辐射剂量与性别、年龄、体质量差异均无统计学意义(P≥0.050).结论 TTE和封堵器的符合率对封堵次数和辐射剂量影响较大,通过提高符合率或可降低封堵次数,减少医师和患者所受辐射剂量.%Objective To explore the effect of measure accuracy of crevasse diameter of atrial septal defect (ASD) by transthoracic echocardiography (TTE) on radiation dose during interventional therapy.Methods 79 cases ASD with interventional therapy in our hospital were analyzed retrospectively,according to the times which we chosen occluder device on the basis of defect diameter by TTE,we divided those cases into three groups:group A,the occluder device chosen well,and it took only one time to block success (50 cases);group B,it took two times to block success (22 cases);group C,because of the measurement error,it needed three times to block success (7 cases).Following data were separately recorded:①measurement values of TTE,size of the occluder device and times of occluder device exchange;② radiation dose [cumulative radiation dose (AK,Gy),area dose product (DAP,Gy · cm2),fluoroscopic time (T,min)];③patient gender,age and body mass.Results All the cases were blocked success,the coincidence rate of TTE and occluder device were 62.67 ％,28 ％,9.33 ％,but there were significantly differences of AK,DAP and T in three groups (FAK=12.119,P=0.000;FDAp=8.241,P=0.001;FT =12.777,P=0.000).It showed that the radiation dose and T of group C were the largest and the longest,and group A were the least and the shortest,while the radiation dose and T of group B ranged between A and C groups.There was no statistically difference between radiation dose for different gender,age,body mass(P≥0.050).Conclusion The times of block and radiation dose is most influenced by the coincidence rate of TTE and occluder device.Increase of the coincidence rate may decrease the times of block and reduce the radiation dose for surgeon and patient.