目的 了解血液透析血管通路常见放射介入操作中患者的辐射剂量水平，评估放射风险。 方法 选择2020年12月1日～2022年8月31日于北京协和医院实施常见血液透析血管通路放射介入操作的成年患者，记录手术中受照时间、摄影帧数、累积剂量(cumulate does，CD)、剂量面积乘积(dose area product，DAP)，计算最高皮肤剂量(peak skin dose，PSD)，进行统计描述与分析。 结果 共收集患者408例，涉及6类术式：带卡夫隧道式透析导管(tunneled cuffed central venous catheter，TCC)置入术223例，动静脉内瘘(arterio-venous fistula,AVF)经皮球囊扩张成形术(percutaneous transluminal angioplasty, PTA)95例、移植物内瘘(arterovenous graft，AVG)-PTA 28例、移植物内瘘血栓清除术(AVG取栓)27例、带卡夫隧道式透析导管置换(TCC置换)并纤维蛋白鞘或中心静脉球囊扩张术(central vein percutaneous transluminal angioplasty，CV-PTA)14例、CV-PTA21例；中位PSD在6类术式分别为1.43(0.60，5.28)、6.33(3.94，9.91)、6.41(2.66，13.09)、7.38(4.23，10.86)、30.52(19.08，52.73)、60.64(36.17，79.92)mGy，中位DAP在这6类术式分别为0.63(0.27，2.26)、4.02(2.57，6.49)、4.21(1.74，8.53)、4.27(2.72，7.13)、13.51(8.44，29.30)、26.84(18.02，35.37)Gy·cm²。 结论 透析通路常见介入操作绝大多数手术为中低剂量操作，辐射安全性好；中心血管介入操作的放射剂量明显高于外周血管介入操作。
Objective To investigate the dose of radiation exposure during the common interventional radiologic procedures for blood access and to evaluate its risks. Methods Data of the adults treated with interventional radiologic procedure for hemodialysis access between December 2020 and August 2022 were retrospectively analyzed. Fluoroscopy time (T), frames (F), dose area product (DAP), and cumulative does (CD) were recorded, and peak skin dose (PSD) was calculated. Standard statistical assessments were employed for the analyses. Results A total of 408 patients were collected, including 6 procedure types of tunneled cuffed central venous catheter placement (TCC placement) 223, arteriovenous fistula-percutaneous transluminal angioplasty (AVF-PTA) 95,arteriovenous graft-PTA(AVG-PTA)28, arteriovenous graft-thrombectomy (AVG-thrombectomy) 27, tunneled cuffed central venous catheter replacement + central vein-PTA (TCC replacement+CV-PTA) 14, and central vein-PTA(CV-PTA) 21; the median PSD was 1.43(0.60,5.28), 6.33(3.94,9.91), 6.41(2.66,13.09), 7.38 (4.23,10.86), 30.52(19.08,52.73), and 60.64(36.17,79.92) mGy respectively; the median DAP was 0.63(0.27,2.26), 4.02(2.57,6.49), 4.21(1.74,8.53), 4.27(2.72,7.13), 13.51(8.44, 29.30), and 26.84(18.02, 35.37) Gy·cm² respectively. Conclusions Most interventional radiologic procedures for hemodialysis access were the exposure of low or medium radiation doses. Radiation exposure doses in central venous intervention procedures were significantly higher than those in peripheral vascular intervention procedures.
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