不同麻醉方式在小儿动脉导管未闭介入治疗中辐射剂量分析

目的：探讨不同麻醉方式在降低小儿动脉导管未闭(PDA)介入治疗中辐射剂量的影响。方法回顾2011—2014年采用2种麻醉方式接受 PDA 介入治疗的小儿(3~6岁)各25例,分为 A、B 2组,A 组为全麻组(男7例,女18例,平均体质量15.32 kg±2.415 kg),B组为局麻组(男13例,女12例,平均体质量16.40 kg±2.056 kg)。2组患者均由相同术者完成手术,采用 DSA 儿童心血管电影自动曝光模式(ped CARD)、摄影帧数15~30 f/s、非离子型对比剂碘克沙醇320 mg I/mL,记录患儿皮肤表面累积入射剂量(AK)、剂量面积乘积(DAP)和透视时间,并作统计学分析。结果50例患儿均顺利完成手术,统计显示,2组患儿的年龄、体质量及性别差异无统计学意义(年龄：t=1.924,P=0.060；体质量：t=1.703,P=0.095；性别：χ2=3.00,P=0.083)；全麻组及局麻组辐射剂量 AK、DAP 及透视时间分别为(0.061±0.025)Gy、(0.094±0.046)Gy；(5.08±2.19)Gy·cm2、(8.41±3.587)Gy·cm2；(3.15±1.16)min、(6.86±3.27)min,差异均有统计学意义(AK：t=3.152,P=0.003；DAP：t=3.957,P=0.000；透视时间：t=5.346,P =0.000),2组在采集序列数及图像数相同的基础上,全麻组辐射剂量明显小于局麻组40%(1-5.08/8.41)%],手术时间相差约1.17倍(3.15-6.86)/3.15]。结论辐射剂量大小与麻醉方式有关,采用全麻方式进行小儿 PDA 介入治疗较局麻方式辐射剂量明显降低40%。

Different type of anesthesia affect radiation dose when do interventional therapy for patent ductus arteriosus

Objective To investigate radiation dose diffent type of anesthesia affected radiation dose when we do interventional therapy for child patent ductus arteriosus (PDA).Methods From 201 1 to 2014,we collected 50 children(3-6 years old)with PDA which received interventional therapy were included in the study.They were divided into two groups:group A (25 cases,male/fe-male=7/18,mean weight=1 5.32 kg±2.41 5 kg)underwent interventional therapy of PDA under general anesthesia,and group B (25 cases,male/female=13/12,mean weight=1 6.40 kg±2.056 kg)using local anesthesia.The surgery were operated by the same doctor,we used DSA children cardiovascular film AE mode (ped CARD)to monitor the surgery,image frames 1 5-30 f/s,used the non-ionic contrast agent (Iodixanol 320 mg I/mL)and recorded the child cumulative incidence of skin surface dose (AK),dose area product(DAP),and time of fluoroscopy,and do statistical analysis.Results All 50 cases were performed the surgery successfully. There were no significant difference of age,weight and gender between groups (age:t=1.924,P =0.06;weight:t =1.703,P =0.095;gender:χ2 =3.00,P =0.083).The cumulative incidence of skin surface dose (AK),dose area product (DAP)and time of fluoroscopy were (0.061±0.025)Gy,(5.08±2.19)Gy·cm2 and (3.15±1.16)min in A group,and (0.094±0.046)Gy,(8.41±3.587)Gy·cm2 , (6.86±3.27)min in B group.The sequence and image number of two groups were same.There were significantly differences of cumulative incidence of skin surface dose (AK),dose area product (DAP)and time of fluoroscopy between two groups (AK:t =3.152,P =0.003;DAP:t =3.957,P =0.000;time of fluoroscopy:t =5.346,P =0.000).The radiation doses of A group significantly lower than B group,compared with B group,the radiation dose were 40 percent (1-5.08/8.41)%]lower in A group,the 1.1 7 times discrepancy of time of fluoroscopy between two group (3.1 5-6.86)/3.1 5].Conclusion Radiation dose is associated with type of anesthesia. Compared with local anesthesia,radiation dose reduced 40% using general anesthesia during interventional therapy for PDA.