CAJ | 학술논문

目的分析阵发性室上性心动过速(PSVT)不同射频消融策略的X线曝光剂量,探索减少术中X线曝光剂量的方法.方法 2013年6月至10月156例在阜外心血管病医院接受射频消融的PSVT患者,根据术者不同分为A、B两组,两组均采用相同的优化后的低剂量透视条件.A组74例,为常规X线透视下行电生理检查及射频消融;B组82例,采用三维标测系统(Ensite-NavX)结合X线透视进行射频消融,术中缩小X线透视窗.记录患者的累积入射剂量(CD)、剂量面积乘积(DAP)、透视时间并换算单位时间放射剂量.结果 A组的累积入射剂量、剂量面积乘积、透视时间分别为22.0(12.0 ～34.0)mGy,130.0(66.7～237.7)μGym2,16.3(11.1 ～26.0)min.B组的累积入射剂量、剂量面积乘积、透视时间分别为6.5(3.0～12.2)mGy,39.5 (20.8 ～ 76.5)μGym2,6.2(3.5～9.1)min.与A组相比,B组在累积入射剂量、剂量面积乘积、透视时间上均明显降低(P值均＜0.001).校正透视时间后,A、B两组累积入射剂量比率分别为1.13(0.81～1.98) mGy/min,1.11 (0.67～1.77) mGy/min,两组间差异无统计学意义(P=0.396),剂量面积乘积比率分别为8.85 (5.91 ～ 12.76) μGym2/min,6.23(3.93 ～10.04) μGym2/min,B组明显低于A组(P=0.007).结论采用三维电场导航系统并缩小X线透视窗,可以明显减少PSVT术中X线曝光剂量.
목적 분석진발성실상성심동과속(PSVT)불동사빈소융책략적X선폭광제량,탐색감소술중X선폭광제량적방법.방법 2013년6월지10월156례재부외심혈관병의원접수사빈소융적PSVT환자,근거술자불동분위A、B량조,량조균채용상동적우화후적저제량투시조건.A조74례,위상규X선투시하행전생리검사급사빈소융;B조82례,채용삼유표측계통(Ensite-NavX)결합X선투시진행사빈소융,술중축소X선투시창.기록환자적루적입사제량(CD)、제량면적승적(DAP)、투시시간병환산단위시간방사제량.결과 A조적루적입사제량、제량면적승적、투시시간분별위22.0(12.0 ～34.0)mGy,130.0(66.7～237.7)μGym2,16.3(11.1 ～26.0)min.B조적루적입사제량、제량면적승적、투시시간분별위6.5(3.0～12.2)mGy,39.5 (20.8 ～ 76.5)μGym2,6.2(3.5～9.1)min.여A조상비,B조재루적입사제량、제량면적승적、투시시간상균명현강저(P치균＜0.001).교정투시시간후,A、B량조루적입사제량비솔분별위1.13(0.81～1.98) mGy/min,1.11 (0.67～1.77) mGy/min,량조간차이무통계학의의(P=0.396),제량면적승적비솔분별위8.85 (5.91 ～ 12.76) μGym2/min,6.23(3.93 ～10.04) μGym2/min,B조명현저우A조(P=0.007).결론 채용삼유전장도항계통병축소X선투시창,가이명현감소PSVT술중X선폭광제량.
Objective To analyse the X ray radiation dose by two ways of radiofrequency catheter ablation(RFCA) in the procedure of paroxysmal supraventricular tachycardia(PSVT),and present a protocol of low radiation exposure.Methods One hundred and fifty-six patients undergoing ablation of PSVT from June 2013 to October 2013 were included and divided into group A and group B according to the operator.A same fluoroscopy system which provided a low radiation dose through optimizing the parameter settings was used.Patients of group A(n =74) were performed by one interventional electrophysiologist,who instituted a practice of traditional fluoroscopic condition and did not minimize the fluoroscopy field specially.Patients of group B (n =82) were performed by another electrophysiologist,who was guided by fluoroscopy and Ensite-NavX electroantomic mapping and kept the fluoroscopy field to minimum.After the procedure,cumulative radiation dose (CD),dose area product (DAP) and fluoroscopy time were measured,then the radiation dose per unit time was calculated.Results Compared with group A,The CD,DAP and fluoroscopy time were significantly reduced in group B from a median of 22.0 mGy to 6.5 mGy(P＜0.001),130.0 μGym2 to 39.5 μ Gym2 (P＜0.001) and 16.3min to 6.2min(P＜0.001).After correcting fluoroscopy time,no significant difference was found between two groups in CD per unit time(1.13 mGy/min vs.1.11 mGy/min,P=0.936),DAP per unit time was significantly reduced in group B from 8.85 μGym2/min to 6.23 μ Gym2/min (P =0.007).Conclusion The radiation exposure can be significantly reduced in the ablation of paroxysmal supraventricular tachycardia by combining fluoroscopy with electroantomic mapping and minimizing the fluoroscopy field.