冠状动脉介入诊疗手术中碘造影剂过敏性休克发生特点及抢救经验

Characteristics and Rescue Strategy in Patients With Iodine Contrast Media Anaphylactic Shock During Percutaneous Coronary Intervention

目的:研究和分析冠状动脉(冠脉)介入诊疗手术中碘造影剂过敏性休克发生的特点与抢救对策,为提高冠脉介入诊疗手术安全提供参考。方法:回顾性分析我院近5年进行的住院冠脉介入诊疗手术病例中,术中发生的碘造影剂过敏性休克病例资料,并对抢救措施进行总结。结果:79 102例冠脉介入诊疗手术病例均使用非离子型碘造影剂,过敏性休克发生率为0.019%(15/79 102)。首发表现包括血压迅速下降(9例)、突发意识障碍(2例)、皮肤黏膜表现等(4例)。发生顽固性休克的患者5例,其中3例患者早期使用大剂量甲基强的松龙冲击治疗最终存活,另外2例死亡患者未早期使用或未使用。5例顽固性过敏性休克中有4例再次接触碘造影剂者,其中2例死亡。结论:冠脉介入诊疗手术中碘造影剂过敏性休克发生率低,但发生过敏性休克的后果严重,尤其是再次接触碘造影剂者。过敏性休克首发表现多样。发生过敏性休克后抢救中在使用肾上腺素等常规抢救药物的基础上及早应用大剂量甲基强的松龙可能有益。

Objective： To analyze the characteristics and rescue strategy in patients with iodine contrast media anaphylactic shock during percutaneous coronary intervention （PCI） in order to improve the PCI safety in clinical practice. Methods： We retrospectively studied 79102 patients who admitted and received PCI or coronary angiography in our hospital in recent 5 years. We particularly focused on patients suffering from iodine contrast media anaphylactic shock, and summarized their medical records with the rescue strategy. Results： All patients received non-ionic iodinated contrast for PCI procedure and the incidence for anaphylactic shock was 0.019% （15/79102）. The immediate manifestation of shock was variable including rapid declined blood pressure （9/15）, consciousness disorder （2/15） and abnormal findings in skin and mucous membrane （4/15）. There were （5/15） of patients with refractory anaphylactic shock, and （3/5） survivals received high-dose methyl prednisolone at the early anaphylactic stage, while （2/5） died without such treatment. （4/5） patients re- exposed to iedinated contrast media including 2 died patients. Conclusion： The iodine contrast media anaphylactic shock was a rare but serious reaction in PCI procedure, the re-exposure could even be worse. Physicians should be alert for immediate manifestation at the early anaphylactic stage, and high dose methyl prednisolone treatment might be helpful for salvaging the patients.