中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2011年
11期
1013-1018
,共6页
刘惠亮%金至赓%杨胜利%马东星%罗建平%刘英%王磊%荆丽敏%孟荣英
劉惠亮%金至賡%楊勝利%馬東星%囉建平%劉英%王磊%荊麗敏%孟榮英
류혜량%금지갱%양성리%마동성%라건평%류영%왕뢰%형려민%맹영영
冠状血管造影术%旋转
冠狀血管造影術%鏇轉
관상혈관조영술%선전
Coronary angiography%Rotation
目的 观察双轴旋转冠状动脉造影(DARCA)在中国人群冠心病诊断中的安全性,探讨其临床应用.方法 选取2010年3月至12月在我院行诊断性DARCA患者共74例,其中后期34例于DARCA时对等中心调整方法进行了改良.于造影前后即刻观察记录患者血压、心率以及症状,并记录造影所用对比剂用量、射线剂量及操作时间.计量资料比较采用Student＇st检验,若呈非正态分布则采用秩和检验,以中位数(M)和四分位数间距(QR)表示；计数资料采用x2检验行统计学分析.结果 (1)临床安全性:所有患者于造影过程中均无胸痛症状,仅1例(1％)于造影后出现短阵室性心动过速,约6s后自行恢复窦性心律.造影前后左冠状动脉收缩压及心率稍降低[收缩压分别为(116±20)、(111±18) mm Hg(1 mm Hg=0.133 kPa),t =3.303,P=0.001；心率的M(QR)分别为73(65 ～84)、71 (64 ～78)次/min,Z=-4.789,P=0.00l],但均在临床正常值内.(2)对比剂、射线剂量及操作时间:所有患者完成造影所需对比剂用量、射线剂量和操作时间分别为28(25 ～34) ml、8979(6733～12 363)mGycm2和200(164 ～ 270)s.等中心调整方法改良后的DARCA其左冠状动脉造影射线剂量及总射线剂量较改良前明显减少[左冠状动脉剂量分别为4004( 2932～5772)、5808 (4798 ～ 8838) mGycm2,Z=-3.471,P=0.001；总剂量分别为(8116±2493)、(11 371±4122) mGycm2,t=-4.176,P=0.001],左冠状动脉造影操作时间及总操作时间也明显减少[左冠状动脉操作时间分别为120(80 ～ 180)、150( 126 ～214)s,Z=-2.836,P=0.005；总操作时间分别为180( 139 ～ 240)、220( 186～308)s,Z=-3.004,P=0.003],但对比剂用量差异无统计学意义[分别为30 (25～35)、27(25 ～34)ml,Z=-0.906,P=0.365].结论 DARCA在中国人群冠心病诊断中具有可靠的安全性,且改良后的DARCA等中心调整方法较常规等中心调整方法在简化操作的基础上可显著减少射线剂量和操作时间,可代替常规法,但临床推广还需大样本随机双盲对照研究结果的支持.
目的 觀察雙軸鏇轉冠狀動脈造影(DARCA)在中國人群冠心病診斷中的安全性,探討其臨床應用.方法 選取2010年3月至12月在我院行診斷性DARCA患者共74例,其中後期34例于DARCA時對等中心調整方法進行瞭改良.于造影前後即刻觀察記錄患者血壓、心率以及癥狀,併記錄造影所用對比劑用量、射線劑量及操作時間.計量資料比較採用Student＇st檢驗,若呈非正態分佈則採用秩和檢驗,以中位數(M)和四分位數間距(QR)錶示；計數資料採用x2檢驗行統計學分析.結果 (1)臨床安全性:所有患者于造影過程中均無胸痛癥狀,僅1例(1％)于造影後齣現短陣室性心動過速,約6s後自行恢複竇性心律.造影前後左冠狀動脈收縮壓及心率稍降低[收縮壓分彆為(116±20)、(111±18) mm Hg(1 mm Hg=0.133 kPa),t =3.303,P=0.001；心率的M(QR)分彆為73(65 ～84)、71 (64 ～78)次/min,Z=-4.789,P=0.00l],但均在臨床正常值內.(2)對比劑、射線劑量及操作時間:所有患者完成造影所需對比劑用量、射線劑量和操作時間分彆為28(25 ～34) ml、8979(6733～12 363)mGycm2和200(164 ～ 270)s.等中心調整方法改良後的DARCA其左冠狀動脈造影射線劑量及總射線劑量較改良前明顯減少[左冠狀動脈劑量分彆為4004( 2932～5772)、5808 (4798 ～ 8838) mGycm2,Z=-3.471,P=0.001；總劑量分彆為(8116±2493)、(11 371±4122) mGycm2,t=-4.176,P=0.001],左冠狀動脈造影操作時間及總操作時間也明顯減少[左冠狀動脈操作時間分彆為120(80 ～ 180)、150( 126 ～214)s,Z=-2.836,P=0.005；總操作時間分彆為180( 139 ～ 240)、220( 186～308)s,Z=-3.004,P=0.003],但對比劑用量差異無統計學意義[分彆為30 (25～35)、27(25 ～34)ml,Z=-0.906,P=0.365].結論 DARCA在中國人群冠心病診斷中具有可靠的安全性,且改良後的DARCA等中心調整方法較常規等中心調整方法在簡化操作的基礎上可顯著減少射線劑量和操作時間,可代替常規法,但臨床推廣還需大樣本隨機雙盲對照研究結果的支持.
목적 관찰쌍축선전관상동맥조영(DARCA)재중국인군관심병진단중적안전성,탐토기림상응용.방법 선취2010년3월지12월재아원행진단성DARCA환자공74례,기중후기34례우DARCA시대등중심조정방법진행료개량.우조영전후즉각관찰기록환자혈압、심솔이급증상,병기록조영소용대비제용량、사선제량급조작시간.계량자료비교채용Student＇st검험,약정비정태분포칙채용질화검험,이중위수(M)화사분위수간거(QR)표시；계수자료채용x2검험행통계학분석.결과 (1)림상안전성:소유환자우조영과정중균무흉통증상,부1례(1％)우조영후출현단진실성심동과속,약6s후자행회복두성심률.조영전후좌관상동맥수축압급심솔초강저[수축압분별위(116±20)、(111±18) mm Hg(1 mm Hg=0.133 kPa),t =3.303,P=0.001；심솔적M(QR)분별위73(65 ～84)、71 (64 ～78)차/min,Z=-4.789,P=0.00l],단균재림상정상치내.(2)대비제、사선제량급조작시간:소유환자완성조영소수대비제용량、사선제량화조작시간분별위28(25 ～34) ml、8979(6733～12 363)mGycm2화200(164 ～ 270)s.등중심조정방법개량후적DARCA기좌관상동맥조영사선제량급총사선제량교개량전명현감소[좌관상동맥제량분별위4004( 2932～5772)、5808 (4798 ～ 8838) mGycm2,Z=-3.471,P=0.001；총제량분별위(8116±2493)、(11 371±4122) mGycm2,t=-4.176,P=0.001],좌관상동맥조영조작시간급총조작시간야명현감소[좌관상동맥조작시간분별위120(80 ～ 180)、150( 126 ～214)s,Z=-2.836,P=0.005；총조작시간분별위180( 139 ～ 240)、220( 186～308)s,Z=-3.004,P=0.003],단대비제용량차이무통계학의의[분별위30 (25～35)、27(25 ～34)ml,Z=-0.906,P=0.365].결론 DARCA재중국인군관심병진단중구유가고적안전성,차개량후적DARCA등중심조정방법교상규등중심조정방법재간화조작적기출상가현저감소사선제량화조작시간,가대체상규법,단림상추엄환수대양본수궤쌍맹대조연구결과적지지.
Objective To observe the clinical safety of dual axis rotational coronary angiography (DARCA) in the diagnosis of coronary artery disease in Chinese population.Methods From March to December in 2010,74 patients undergoing diagnostic DARCA were enrolled.The improved isocentering technique was adopted in 34 of the patients at the end of the study during DARCA.Blood pressure,heart rate and symptoms were recorded immediately before-and-after contrast injections.Contrast dose,radiation exposure and procedure time for DARCA were recorded.Continuous variable data were analyzed using Student＇s t test,if normality assumption was violated,rank sum test would be used.Categorical variables were analyzed using x2 test.Results ( 1 ) Clinical safety:There was no chest pain documented during or immediately post-injection for all patients.Only 1 patient ( 1 ％ ) had an attack of ventricular tachycardia immediately after the contrast injection and then relieved automatically.Pre and post-injection systolic blood pressure values of left coronary artery were statistically different [ ( 116 ± 20 ) mm Hg vs.( 111 + 18) mm Hg( 1 mm Hg =0.133 kPa),t =3.303,P =0.001 ],and heart rates differed,too [ 73 ( 65- 84)bpm vs.71(64-78) bpm,Z =-4.789,P =0.001 ],but that imposed no clinical significance.(2)Contrast dose,radiation dose and procedure time:The mean contrast utilization,radiation dose and procedure time for DARCA were 28 (25-34) ml,8979 ( 6733-12 363 ) mGycm2 and 200 (164-270) s.Compared with conventional DARCA,improved isocentering technique during DARCA had less radiation exposure and procedure time in left coronary artery angiography and the whole coronary artery angiography [ left coronary artery angiographic radiation exposure:4004 (2932-5772) mGycm2 vs.5808 (4798- 8838) mGycm2,Z =-3.471,P =0.001 ;total radiation exposure:(8116 +2493) mGycm2 vs.( 11 371 ±4122) mGycm2,t =-4.176,P =0.001 ; left coronary artery angiographic procedure time:120 ( 80-180)s vs.150(126-214) s,Z =- 2.836,P =0.005; total procedure time:180 (139-240) s vs.220( 186-308 )s,Z =-3.004,P =0.003 ],but there was no statistically difference in contrast utilization [30(25-35) ml vs.27(25-34)ml,Z=-0.906,P=0.365].Conclusion This study demonstrates clinical safety of DARCA in the diagnosis of coronary artery disease in Chinese population.Compared with conventional isocentering technique of DARCA,improved isocentering technique can significantly reduce radiation exposure and procedure time on the basis of simplified operation,and replace the conventional isocentering technique,but randomized double-blind controlled studies should be conducted.
