| Objective:To investigate the feasibility of using optimized protocol of iodine contrast media with fixed injection time in“triple-rule-out”CT angiography(TRO-CTA)of acute chest pain patients with Revolution CT.The relevant nursing influencing factors affecting image quality of patients with low-dose iodine contrast media during the examination were analyzed.Meanwhile,coronary image quality and radiation dose were compared between TRO CTA and gem CT coronary angiography(CCTA).In order to provide systematic basis for establishing a feasible"double low"(low contrast media dosage,low radiation dose)protocol of TRO-CTA and making a comprehensive nursing intervention program for chest pain patients during the examination.Methods:Part ?:Evaluate the effect of iodine contrast media optimization with fixed injection time in TRO-CTAA prospective,consecutively enrolled 92 patients who underwent TRO-CTA of acute chest pain from September 2017 to November 2018,including 75 inpatients and 17outpatients.According to the body mass index(BMI),44 cases were group A(?23kg/m~2)and 48 cases were group B(>23kg/m~2).Then,group A and group B were divided into two subgroups according to the random number table method.There were 22 cases in arm A1 and arm A2,and 24 cases in arm B1 and arm B2.The iodine contrast media(370mgI/ml)injection optimization protocol for fixed injection time(14s)was given to the patient,and both the protocol 1 and the protocol 2 were optimized low-dose injection protocols.Protocol 1(55ml):iodinated contrast media was first injected at 5ml/s for 8s,followed by the same contrast media was injected at 2.5ml/s for 6s,finally followed by injection of 40mL of saline injected at a rate of 2.5 mL/s;Protocol 2(60ml):iodinated contrast media was first injected at 5ml/s for 10s,followed by the same contrast media was injected at 2.5ml/s for 4s,finally followed by injection of 40mL of saline injected at a rate of 2.5 mL/s.Protocol 1 is used to arm A1 and arm B1,and protocol 2 is used to arm A2 and B2.All patients did not give metoprolol to control heart rate.Compare the image quality(primary and objective assessment)and the overall effective radiation dose for the completed examination of the A1 and A2 arms,B1 and B2 arms.Part ?:Analysis of the effect of individualized factors on image quality in TRO-CTA of chest painRetrospectively collected images data and case data of 75 inpatients who underwent a TRO-CTA of the chest pain in our hospital from September 2017 to December 2018,including gender,age,BMI,resting heart rate,scan Heart rate,heart rate variability,arrhythmia,chronic disease history,cardiac function grading and iodine contrast media application used in the examination.The relationship between patient individualization factors and image quality scores of blood vessels at various sites was analyzed.Part ?:Evaluate the difference of coronary image quality and radiation dose between TRO-CTA and gem CCTAThe case data and imaging data of 46 patients who underwent TRO-CTA examination with 60ml iodine contrast media were used as the experimental group(group C).Retrospective collection of case data and imaging data of 40 patients who completed the gem CCTA in our hospital were used as the control group(group D).Coronary image quality and radiation dose were compared between TRO CTA and gem CCTA.The data were analyzed by SPSS22.0 statistical software for t test,analysis of variance,nonparametric test and logistic regression analysis.When the value of P was less than0.05,the difference was statistically significant.Results:(1)In the discussion of the protocol of low-dose iodine contrast media:the difference in pulmonary artery image quality between the A1 and A2 arms was statistically significant(P<0.05),and the image quality of pulmonary artery in the A1arm was better than that in the A2 arm.There was no significant difference in coronary artery and aortic image quality(P>0.05).There was no significant difference in pulmonary artery image quality between the B1 and B2 arms(P>0.05).The difference in coronary artery and aortic image quality was statistically significant(P<0.05),and the B2arm had better coronary and aortic image quality than B1 arm.There was no significant difference in the effective radiation dose between groups A and B(P>0.05).(2)The vascular image quality of all the 95 patients with TRO-CTA met the diagnostic requirements.The mean subjective score of pulmonary artery,coronary artery and aortic of 75 inpatients were 3.85±0.36,3.28±0.65,3.15±0.82,respectively.(3)Univariate analysis showed that there was a statistically significant difference in the influence of BMI and cardiac insufficiency on pulmonary artery image quality(P<0.05).BMI,cardiac insufficiency and contrast media dosage had significant effect on coronary image quality P<0.05);BMI,resting heart rate,heart rate during scanning and contrast media dosage had significant effects on aortic image quality(P<0.05).Multiple regression results showed that BMI and cardiac insufficiency were the main influencing factors of pulmonary artery.Cardiac insufficiency and contrast media dosage were the main factors affecting the quality of coronary images.BMI and contrast media dosage were the main influencing factors of aortic image quality.(4)Comparison of TRO-CTA and gem CT coronary angiography showed no statistically significant difference in coronary artery image quality(P>0.05)and statistically significant difference in radiation dose of coronary artery(P<0.05).Conclusions:(1)The low-dose iodine contrast media application program with fixed injection time can meet the needs of clinical diagnosis of TRO-CTA examination of acute chest pain.For patients with BMI?23kg/m~2,both protocol 1 and 2 can obtain excellent image quality.In order to avoid the influence of superior vena cava artifacts,it is recommended to use protocol 1;for patients with BMI>23kg/m~2,application protocol 2 can Obtain stable,excellent image quality that is more suitable for clinical applications.(2)Before the TRO-CTA of chest pain,the nursing staff should pay attention to collecting the case information for giving a comprehensive evaluation to the patient,and do the appropriate nursing intervention and quality control in order to obtain better imaging information.(3)The advantages of Revolution CT combined scanning are obvious.The radiation dose of TRO-CTA is lower than that of previous studies.The radiation dose of the coronary artery scanning in TRO-CTA was significantly lower than that of the gem CT coronary angiography. |
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