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目的了解小儿先天性心脏病(先心病)介入诊疗中受检者的辐射剂量,以便有效开展和加强受检者医疗照射的防护,降低受检者的辐射剂量。方法158例介入治疗患儿,其中男性77例,女性81例;年龄3个月～13岁,平均年龄4岁;体质量5.7～42.0 kg,平均体质量14.2 kg。动脉导管未闭(PDA)封堵术118例,肺动脉狭窄(PS)球囊扩张术40例。采用数字减影血管造影,电影采集模式为小儿心血管模式(ped CARD);帧频控制30 f/s;透视模式为脉冲控制,4 f/s;根据年龄不同选择管电压在60～70 kV,管电流自动调节;对比剂为非离子型370 mgI/mL碘普罗胺。回顾性分析不同术式、不同年龄患儿进行透视时间、皮肤辐射剂量。结果PDA透视时间(4.66±3.59)min,PS(5.62±2.79)min,两种手术透视时间差异无统计学意义(P>0.05);但在同一种手术中透视时间差异较大。皮肤辐射剂量范围1.20~107.00 mGy,平均皮肤辐射剂量22.45 mGy;PDA患儿诊疗时,透视+电影采集总皮肤辐射剂量为(20.24±13.52)mGy;PS患儿诊疗时,透视+电影采集总皮肤辐射剂量为(41.88±29.24)mGy;两组患儿皮肤辐射剂量比较,差异有统计学意义(P<0.05)。不同年龄的皮肤辐射剂量比较,差异有统计学意义(P<0.05);不同体质量的皮肤辐射剂量比较,差异有统计学意义(P<0.05)。结论不同种类手术透视时间的长短与年龄、体质量关系不大,造成透视时间差异显著的主要原因是患儿病变的部位、性质、形态、大小及手术操作者的操作技术和防护意识,要降低辐射剂量,就要缩短透视时间,提高手术操作者的操作技术和防护意识是至关重要。
Objective To understand the radiation dose of subjects during pediatric congenital heart disease (CHD) interventional therapy in order to effectively carry out and enhance the protection of medical exposure and reduce the radiation dose of the subjects. Methods A total of 158 children were enrolled in the interventional treatment, including 77 males and 81 females. The average age was 3 months to 13 years. The average age was 4 years. The body weight ranged from 5.7 to 42.0 kg with an average body weight of 14.2 kg. 118 cases of patent ductus arteriosus closure (PDA) and 40 cases of pulmonary artery stenosis (PS) balloon dilatation. Using digital subtraction angiography, the film acquisition mode was ped CARD; the frame rate was controlled at 30 f / s; the fluoroscopy mode was pulse control at 4 f / s; the tube voltage was selected from 60 to 70 kV , The tube current is automatically adjusted; contrast agent non-ionic 370 mgI / mL iopromide amine. Retrospective analysis of different surgical procedures, children of different ages for fluoroscopy, skin radiation dose. Results The time of PDA fluoroscopy was (4.66 ± 3.59) min and PS (5.62 ± 2.79) min, respectively. There was no significant difference in the time of fluoroscopy between the two operations (P> 0.05). However, the fluoroscopy time was significantly different in the same operation. Skin radiation dose range 1.20 ~ 107.00 mGy, the average skin radiation dose 22.45 mGy; PDA diagnosis and treatment of fluoroscopy + film total skin radiation dose (20.24 ± 13.52) mGy; PS treatment of children, fluoroscopy + film collection of total skin The radiation dose was (41.88 ± 29.24) mGy. There was significant difference in skin radiation dose between the two groups (P <0.05). There were significant differences in skin radiation doses at different ages (P <0.05). There was significant difference in skin radiation dose between different body weight (P <0.05). Conclusions The main reason for the significant difference in fluoroscopy time is the location, nature, shape and size of the lesions and the operating skills and protective awareness of the surgeons, which should be reduced Radiation dose, it is necessary to shorten the fluoroscopy time, improve the operating skills of surgical operators and protection awareness is essential.