碘对比剂外渗皮肤反应不同治疗方案的对照研究

Iodine Contrast Agent Extravasation:Comparative Study among Variant Treatments

目的:比较不同治疗方案对碘对比剂皮肤外渗反应的治疗效果。方法:自2010年1月至2012年1月,对84例碘对比剂皮肤外渗反应病例随机使用硫酸镁敷剂+冷敷、磺胺嘧啶银敷剂+冷敷和单纯冷敷治疗。分别在反应后第1、2、3、7天评估皮肤颜色、肢体肿胀程度、局部循环以及患肢功能状况。比较不同治疗方案的治疗效果。结果:45例外渗反应在1天后、18例在2天后、11例在3天后基本痊愈,仅1例出现骨筋膜室综合征,经切开治疗后痊愈,病程超过7天。其中磺胺嘧啶银+冷敷组痊愈最快(χ2a-b=32.56,Pa-b=0.001,χ2b-c=41.02,Pb-c<0.001)。出现反应后1～3天内磺胺嘧啶银组皮肤颜色恢复显著快于其他两组(χ2皮肤a-b=23.10,P皮肤a-b=0.006;χ2皮肤b-c=24.87,P皮肤b-c=0.003);反应后7天,三组在各项评分方面无显著差异(P>0.05)。结论:绝大部分碘对比剂皮肤外渗反应在1天内均有显著好转,7天内基本可痊愈;外渗反应可引起骨筋膜室综合征,宜早诊断并手术治疗;磺胺嘧啶银+冷敷治疗效果更佳。

Purpose:To compare the results of variant iodine contrast agent extravasation treatments.Methods: Eight-four iodine contrast agent extravasation cases,which were occoured during from Jun.2010 to Jun.2012,were performed with magnesium sulfate external application,sulfadiazine silver(SD-Ag) or cold compression randomly.It were evaluated as the treatment results that skin color,swelling,forearm function and local circulation during 1,2,3,7 days after extravasation.Results: Forty-five cases were healed after 1 day,18 cases after 2 days and 11 cases after 3 days.One osteofascial compartment syndrome case was performed fasciotomy and the healing duration were 14 days.The patients with SD-Ag treatments were healed most quickly,(χ2a-b=32.56,Pa-b=0.001,χ2b-c=41.02,Pb-c<0.001).Skin color recovery in patients with SD-Ag treatments was better than the other groups within 3 days(χ2skin color a-b=23.10,P skin color a-b =0.006;χ2 skin color b-c=24.87,P skin color b-c =0.003).No variance were confirmed between 3 groups after 7 days(P>0.05).Conclusion: Most iodine contrast agent extravasation cases were recovered within 7 days,but few cases with osteofascial compartment syndrome would be performed surgical treatment.SD-Ag and cold compression were recommended to treat the extravasation.