【摘要】：目的：測量各類心血管介入在診療過程中患者所受的X射線輻射劑量，記錄透視時間，分析各種介入輻射劑量；調查心血管介入術前及術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，加強輻射防護。 方法：1.分析安徽醫(yī)科大學第一附屬醫(yī)院心血管內科介入手術詳細記錄442例患者的輻射劑量資料，測量患者的面積劑量乘積DAP值、入射劑量CD值及透視時間，進行參數比較，并比較甲、乙、丙三位術者的患者輻射劑量。2.對心血管介入診療的100例住院患者采集外周血，分為術前及術后自身對照。術后記錄患者輻射劑量，根據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，檢測每組患者術前及術后淋巴細胞染色體畸變率和微核率。 結果：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脈造影透視時間較短，輻射劑量較小；冠狀動脈支架術和射頻消融術透視時間較長，輻射劑量較大。各類心血管介入操作中冠狀動脈介入術的入射劑量和劑量面積乘積較大，射頻消融時間相對較長。術者甲的患者輻射劑量明顯低于乙和丙。按照ICRP劑量分類的參考標準，兒童心血管介入術中所受輻射劑量較小，僅2.1%的患兒CD值超過1.0Gy。2.在4組輻射劑量中，術后2h、24h、72h染色體畸變率及微核率與術前相比，㩳0.5Gy組差異無統(tǒng)計學意義，其他三組均有統(tǒng)計學意義（P均㩳0.05），其中2.0Gy組與術前相比明顯增多(P㩳0.01)。術后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）。冠狀動脈介入治療患者術后染色體畸變率及微核率明顯增高。部分復雜的房顫射頻消融術患者出現染色體畸變和微核。 結論：1.影響心血管介入輻射劑量的因素較多，包括病變程度、操作者手術熟練程度、透視時間等。2.心血管介入患者中部分出現染色體畸變微核。患者術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。關鍵是在保證手術質量的前體下，增強操作者的劑量意識，縮短患者的透視時間，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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R144

【相似文獻】

相關期刊論文 前10條

1 趙明剛;施常備;趙華;袁勇;姚俊濤;陸建榮;袁彬;陳葳;王翔;;輻射后淋巴細胞的G顯帶染色體畸變分析[J];現代腫瘤醫(yī)學;2011年07期

2 楊品清,王芝琪,孫玉富,馮軍,季海坤,張雅坤;15～100倫~(60)鈷γ線照射離體人血誘發(fā)淋巴細胞染色體畸變與劑量的關系[J];哈爾濱醫(yī)科大學學報;1985年04期

3 ;小劑量受照人員細胞遺傳學隨訪觀察[J];中國輻射衛(wèi)生;1992年01期

4 詹江海;鄧志誠;張連珍;王素琴;陳保文;郝雅羿;;~(60)Coγ射線誘發(fā)早熟凝聚染色體畸變的劑量效應關系[J];輻射防護通訊;1990年04期

5 白玉書;朱壬葆;;電離輻射與血細胞微核率[J];國際放射醫(yī)學核醫(yī)學雜志;1981年03期

6 杜杰;陳英;閆學昆;方軍;張學清;;快中子與~(60)Co-γ射線誘發(fā)人淋巴細胞生物效應研究[J];中國輻射衛(wèi)生;2009年04期

7 丁延淑;崔允文;王毅;王素桂;任國慶;薛虹;;服用甾體口服避孕藥婦女妊娠胎兒染色體畸變和姐妹染色單體交換(SCE)的研究[J];首都醫(yī)科大學學報;1983年03期

8 丁延淑;崔允文;王毅;王素桂;任國慶;薛虹;;服用甾體口服避孕藥婦女妊娠胎兒染色體畸變和姐妹染色單體交換(SCE)的研究[J];福建醫(yī)科大學學報;1983年03期

9 陳立男,李璞,范耀山,王志春,李洪勝;~(131)Ⅰ治療前后甲亢患者的染色體畸變[J];哈爾濱醫(yī)科大學學報;1985年04期

10 吳國用;崔山田;李蓮姬;沈美善;韓春姬;;低分子鉻結合物對人外周血淋巴細胞染色體畸變及姐妹染色單體互換的影響[J];延邊大學醫(yī)學學報;1988年03期

相關會議論文 前10條

1 鄭暉;;數字影像質量與如何控制受檢者輻射劑量的思考[A];2009中華醫(yī)學會影像技術分會第十七次全國學術大會論文集[C];2009年

2 王振;;手臂上舉姿勢對管電流調節(jié)多層CT胸部掃描輻射劑量的影響[A];2010中華醫(yī)學會影像技術分會第十八次全國學術大會論文集[C];2010年

3 陳傳亮;郭o

本文編號：2120434