非离子型冠脉造影剂致急性严重过敏样反应的病例分析

Analysis of Acute Severe Anaphylaxis Cases of Nonionic Coronary Contrast Media

目的对非离子型冠脉造影剂引起的急性严重过敏样反应进行总结和分析。方法回顾总结2007年12月至2009年12月在我院进行冠状动脉造影和/或介入治疗的24314例患者,对发生冠脉造影剂引起的急性严重过敏样反应的病例进行研究,分析其临床特点。结果9例患者在接受非离子型碘造影剂血管内注射后1小时之内发生严重过敏样反应,发生率0.037%,其临床主要表现为血压突然降低,伴不同程度的心律失常,及其他系统的伴随症状。给予吸氧、补液以及大剂量应用升压药物(尤其是肾上腺素)和糖皮质激素等治疗可有效缓解症状。结论非离子型冠脉造影剂在临床应用中总的安全性良好,但在应用过程中应重视急性严重过敏样反应的识别与处理。

Objective To summarize and analyze acute severe anaphylactoid reaction cases of nonionic coronary contrast media during coronary angiography and/or percutaneous coronary intervention.Methods We retrospectively evaluated the outcomes of 24 314 patients undergoing coronary angiography and/or percutaneons coronary intervention in our hospital from December 2007 to December 2009,and analyzed the cases with acute severe anaphylactoid reactions to nonionic contrast media.Results 9 patients exhibited severe anaphylactoid reactions to nonionic contrast media,which typically occured within 1 hour after intravascular injection.The incidence is about 0.037%.The main symptom of severe anaphylactoid reactions to nonionic contrast media was significantly lower blood pressure,with various degree of arrhythmia,accompanied by symptoms of other systems.Oxygen,rehydration,and application of high-dose boost drugs（especially epinephrine） and corticosteroids were effective methods of treatment.Conclusion Nonionic contrast media can be used safely during coronary angiography and/or percutaneous coronary intervention.However,in the application process,identification and treatment for acute severe anaphylactoid reactions should be strengthened.