摘要：
Objective To investigate the effect of optimized radiological examination strategy on iatrogenic radiation exposure in severe trauma patients so as to provide scientific basis for standardized application of radiological examination.Methods A controlled, three-stage intervention study from April 2010 to November 2011 was carried out.From April 2010 to July 2010, a pre-intervention study was conducted and enrolled 60 patients [43 males, 17 females;age (50 ± 14)years, age range 23-78 years].From August 2010 to March 2011, optimized strategies of radiological examination were implemented, including improving clinicians' knowledge to the standardization of radiological examination and iatrogenic radiation injury and limiting frequency of CT scans through the electronic medical record.From April 2011 to November 2011, post-intervention study was conducted and enrolled 100 patients (81 males, 19 females;age (47 ± 14) years, age range 18-79 years].During this period, major trauma patients were analyzed with respect to the clinical information, radiation examination frequency, ionizing radiation dose and influencing factors.Radiation examination frequency and radiation dose were compared before and after the intervention.Results Radiological examinations were mainly X-ray and CT before the implication of optimized strategies.Of the 60 patients, median frequency of X-rays and CT scan was 6.0(3.0-11.0) and 10.0(8.0-13.8).Median frequency of CT scan was positively correlated with the injury severity score (ISS) and ICU length of stay (r =0.369 and 0.523, P ＜ 0.05).Of the 100 patients, median frequency of CT scan was significantly reduced after the optimization of radiological examination (8.0 vs.10.0, P ＜ 0.05).Total frequency of radiological examination was significantly reduced as well (13.6 vs.17.8, P ＜0.01).There was no significant difference in the treatment success rate before and after the optimization of radiological examination (85.0％ vs.88.3％, P ＞ 0.05).When the frequency of head and chest CT scan was limited, the frequency of radiological examination, radiation exposure and radiological examination expenses were greatly reduced.Conclusions Too much X-ray,CT or other radiological examinations are noted in major trauma patients during the treatment period.Improved understanding of radiation-induced injury, optimizing radiological examination and controlling the repeated radiological examinations of the same site contribute to reducing iatrogenic radiology exposure without affecting the outcome.%目的 探讨采取优化的放射学检查策略对严重创伤患者医源性辐射暴露量的影响,为进一步规范创伤的放射学检查提供依据. 方法 本研究为临床干预前后对照研究.2010年4月-2011年11月分三个阶段实施:2010年4-7月进行干预前调查(第一阶段),共纳入60例患者,其中男43例,女17例;年龄23 ～78岁[(50±14)岁].2010年8月-2011年3月逐步实施优化的放射学检查策略(第二阶段),包括加强临床医师对创伤放射学检查规范及医源性辐射损伤的认识、通过电子病历系统限制患者CT检查部位数.2011年4-11月为干预后观察(第三阶段),共纳入100例患者,其中男81例,女19例;年龄18 ～ 79岁[(47±14)岁].收集研究期间严重创伤患者的临床信息、放射学检查的次数、辐射剂量和影响因素,比较干预前后患者放射学检查的次数和辐射剂量的变化. 结果 (1)第一阶段60例患者住院期间接受的放射学检查主要为X线片和CT检查,人均摄片6.0次(四分位数3.0～11.0次),CT检查10.0次(8.0～13.8次),CT检查次数与损伤严重度评分(ISS)和ICU住院天数相关(r=0.369,0.523,P均＜0.05).(2)第三阶段100例患者人均CT检查次数较第一阶段显著减少(8.0次:10.0次,P＜0.05),总放射学检查次数也减少(13.6次:17.8次),P＜0.01,救治成功率无明显变化(85.0％:88.3％),P＞0.05.(3)控制患者头颅及胸部CT复查次数,进一步降低了放射学检查次数、辐射暴露和放射学检查费用. 结论 严重创伤患者救治期间接受较多的放射学检查,应提高临床医师对辐射损伤的认识、优化放射学检查制度、减少同一部位复查次数,可有效减少患者的医源性辐射暴露而不影响救治效果.
