用于诊断冠状动脉血管学和穿皮冠状动脉干预的动脉接入部位的辐射暴露:系统审查和元分析
Guillaume Plourde1, Samir B Pancholy2, Jim Nolan3
1Quebec Heart-Lung Institute, Laval University, QC, Canada.
心脏手术的超射线接入略有增加了辐射暴露,但并发症率较低. 这种微小的辐射增加不太可能超过跨辐射接入的好处.
科学领域:
- 心脏病学
- 干预心脏病学
- 放射学
背景情况:
- 由于减少出血和血管并发症,在心脏导管治疗中偏好透射接入 (TRA),而不是输血接入 (TFA).
- 然而,人们对TRA潜在的更高辐射暴露存在担忧.
- 这种辐射差异的临床意义需要评估.
研究的目的:
- 在诊断冠状动脉图和皮肤冠状动脉干预 (PCI) 中比较TRA和TFA的辐射暴露.
主要方法:
- 随机对照试验 (RCT) 和观察性研究的系统审查和元分析.
- 在PubMed,Embase和Cochrane图书馆的数据库中进行搜索.
- 专注于光镜时间和kerma-area产品;作为次要结果,分析了操作员辐射剂量和手术时间.
主要成果:
- 与TFA相比,TRA与诊断血管造影和PCI的光镜时间略有但显著增加.
- 对于PCI,KERMA的产量也更高.
- 操作人员的辐射剂量随着保护水平的变化而变化,但TRA通常显示额外的保护剂量较低.
- 在过去的20年中,TRA和TFA的光学时间差异显著减少.
结论:
- 与转接入相比,透射接入与辐射暴露的轻微增加有关.
- 这种增加不太可能超过TRA的确定的临床益处.
- 随着时间的推移,辐射暴露的差距越来越小,进一步支持TRA的临床实用性.
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