血管内使用含碘造影剂诱发的肾中毒

Intravascular Iodinated Contrast-Medium-Induced Renal Toxicity

本文复习含碘造影剂诱发急性肾功能衰竭的有关文献。其诱发因素有:肾功能不全、糖尿病、脱水、心血管疾病并使用利尿剂、高龄(70岁以上)、以及多发性骨髓瘤并脱水等。其发生机理为:血液动力学异常、肾小管内梗阻、肾小管细胞损伤、脱水引起的“肾前性”低血压,以及免疫学因素等。其预防措施包括:避免高危病人使用造影剂、避免病人脱水、延长使用造影剂的间隔时间、选用合适的造影剂和合适的剂量。

This paper reviewed the medical literature concerning intravascular iodinated contrast medium-induced renal toxicity(CM-ARF).Possible predisposing factors for CM-ARF include:pre- existing renal insufficiency,diabetes mellitus,dehydration,cardiovascular disease and diuretics,ad vanced age(≥70 years),and multiple myeloma(in dehydrated patients).The hypothetical mechanisms of CM-ARF are:hemodynamic alterations,intratubular obstruction,tubular cell damage,”prerenal” hypotension(dehydration),and immunologic factors.The prevention of CM-ARFinclude:careful patient selection(avoid risk factors),avoid dehydration,increase intervals between contrast-enhanced exams, and selecting the type and dose of contrast medium carefully.