【摘要】：目的：測(cè)量各類心血管介入在診療過(guò)程中患者所受的X射線輻射劑量，記錄透視時(shí)間，分析各種介入輻射劑量；調(diào)查心血管介入術(shù)前及術(shù)后患者染色體畸變率和微核率情況，探討影響輻射劑量的因素及減少輻射損傷的方法，加強(qiáng)輻射防護(hù)。 方法：1.分析安徽醫(yī)科大學(xué)第一附屬醫(yī)院心血管內(nèi)科介入手術(shù)詳細(xì)記錄442例患者的輻射劑量資料，測(cè)量患者的面積劑量乘積DAP值、入射劑量CD值及透視時(shí)間，進(jìn)行參數(shù)比較，并比較甲、乙、丙三位術(shù)者的患者輻射劑量。2.對(duì)心血管介入診療的100例住院患者采集外周血，分為術(shù)前及術(shù)后自身對(duì)照。術(shù)后記錄患者輻射劑量，根據(jù)患者所受輻射劑量不同，再分為4組，即低于0.5Gy組，0.5~1.0Gy組，，1.0~2.0Gy組，以及2.0Gy以上組，檢測(cè)每組患者術(shù)前及術(shù)后淋巴細(xì)胞染色體畸變率和微核率。 結(jié)果：1.不同心血管病介入操作患者的輻射劑量存在明顯差異。先天性心臟病和冠狀動(dòng)脈造影透視時(shí)間較短，輻射劑量較小；冠狀動(dòng)脈支架術(shù)和射頻消融術(shù)透視時(shí)間較長(zhǎng)，輻射劑量較大。各類心血管介入操作中冠狀動(dòng)脈介入術(shù)的入射劑量和劑量面積乘積較大，射頻消融時(shí)間相對(duì)較長(zhǎng)。術(shù)者甲的患者輻射劑量明顯低于乙和丙。按照ICRP劑量分類的參考標(biāo)準(zhǔn)，兒童心血管介入術(shù)中所受輻射劑量較小，僅2.1%的患兒CD值超過(guò)1.0Gy。2.在4組輻射劑量中，術(shù)后2h、24h、72h染色體畸變率及微核率與術(shù)前相比，㩳0.5Gy組差異無(wú)統(tǒng)計(jì)學(xué)意義，其他三組均有統(tǒng)計(jì)學(xué)意義（P均㩳0.05），其中2.0Gy組與術(shù)前相比明顯增多(P㩳0.01)。術(shù)后2h、24h、72h4組之間相比較，2.0Gy組染色體畸變率及微核率明顯增高（P均㩳0.05）。1.0～2.0Gy組與0.5～1.0Gy組、㩳0.5Gy組比較，染色體畸變率及微核率明顯增高（P均㩳0.05）。冠狀動(dòng)脈介入治療患者術(shù)后染色體畸變率及微核率明顯增高。部分復(fù)雜的房顫射頻消融術(shù)患者出現(xiàn)染色體畸變和微核。 結(jié)論：1.影響心血管介入輻射劑量的因素較多，包括病變程度、操作者手術(shù)熟練程度、透視時(shí)間等。2.心血管介入患者中部分出現(xiàn)染色體畸變微核�；颊咝g(shù)后染色體畸變率及微核率隨著輻射劑量的增加而升高。3.在心血管介入操作中輻射不可避免。兒童輻射劑量雖偏小，但輻射損傷的敏感性很大。關(guān)鍵是在保證手術(shù)質(zhì)量的前體下，增強(qiáng)操作者的劑量意識(shí)，縮短患者的透視時(shí)間，減少輻射劑量。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R144

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