冠状动脉介入干预后造影剂脑病的特点

An initial study on contrast-induced encephalopathy after percutaneous coronary intervention

目的:探讨冠状动脉介入干预后造影剂脑病(CIE)的发病率、疾病特点、治疗方法及预后。方法:对2014-01-2016-07进行冠状动脉介入干预的1 554例患者中出现的CIE进行分析。结果:1 554例中8例(0.51%)患者出现CIE,1例表现为左、右侧交替肢体无力及意识障碍(1年前应用相同造影剂无不适),7例表现为视物模糊。8例CIE患者均应用非离子型造影剂,其中5例应用低渗造影剂碘帕醇370,2例应用等渗造影剂碘克沙醇320,1例应用低渗造影剂碘普罗胺370。8例经对症治疗后,恢复快,无神经系统后遗症。结论:CIE发生率低,非离子型的等渗和低渗造影剂均可诱发CIE,视物模糊多发,经支持治疗后预后好。对于出现CIE的患者,在需要重复应用造影剂时可慎重使用。CIE的发病机制和预防方法有待进一步研究。

Objective：To assess the clinical characteristics of contrast-induced encephalopathy（CIE）after percutaneous coronary intervention,including the morbidity,disease characteristics,treatment strategy and prognosis.Method：We reviewed the clinical data in 1554 patients after percutaneous coronary interventiona from January2014 to July 2016.And the patients with CIE were analyzed.Result：The 8patients（0.51%）had CIE.One patient showed alternating limb weakness and disturbance of consciousness after 1year with the same contrast agent,who had no symptoms in the first time.The other 7patients showed visual disturbance.The 8patients were all treated with non-ionic contrast agent,5with low permeability contrast agent iopamidol 370,2with isosmolar iodixanol 320 and 1with low permeability contrast agent iodide 370.The 8patients with CIE recovered completely without any neurological deficits.Conclusion：Incidence rate of CIE was low.Non ionic agent,either isosmolar contrast agent or low permeability one,could induce CIE.High incidence of visual disturbance and good prognosis were found with CIE.Re-jnjection of contrast agent in such patients can be undertaken with caution.The pathogenesis and preventive intervention of CIE remain to be further studied.