7种静脉注射碘对比剂的合理应用及其不良反应分析

Rational application and analysis of its adverse reaction for 7 iodine contrast-medium intravenous injections

目的:探讨7种碘对比剂静脉注射的临床诊疗中的合理应用,总结不良反应相关因素及最佳处理方法。方法:依据对比剂含碘浓度、渗透压、剂量、价格、患者性别、年龄、体重指数(BMI)、血压、内生肌酐清除率(Ccr,μmol·L^(-1))、基础病史、CT增强扫描部位及对比剂不良反应(ADR)发生情况,初步制定碘对比剂合理应用方案;总结7种碘对比剂所致急性、晚发性及超晚发性不良反应发生率、发生特点及相应临床处理方法。结果:(1)7种类型碘对比剂临床应用情况不同;(2)碘对比剂ADR共128例,其中急性94例、晚发不良反应31例、超晚发不良反应3例,发生率在正常范围内;皮肤过敏最常见,共83例(64.8%),胃肠道反应19例(14.8%),呼吸系统17例(13.2%),心血管系统4例(3.1%),中枢神经系统3例(2.3%),泌尿系统1例(0.7%),多系统症状至死亡1例(0.7%);(3)多因素Logistic回归分析显示,年龄(OR=0.96,P=0.021),使用前加热(OR=1.74,P=0.028),注射流速(OR=1.28,P=0.001),扫描部位(OR=0.73,P=0.041)是不良反应的独立危险因素。结论:年龄、使用前加热、注射流速、扫描部位是非离子型碘对比剂不良反应的独立危险因素;正确合理使用碘对比剂能够为患者疾病诊断提供最佳的检查手段并有效降低不良反应发生率,提高医务工作者对碘对比剂不良反应处理的意识。

OBJECTIVE To explore the reasonable application of 7 iodine contrast agents in the clinical diagnosis and treatment,and summarize the related factors and the best treatment methods.METHODS On the basis of iodine contrast agent concentration,osmotic pressure,dosage,price,sex and age of patients,blood pressure,BMI,Ccr（mL·min^（-1））,disease history,location and contrast enhanced CT scan,the incidence of adverse drug reactions（ADRs）,the preliminary reasonable application scheme was developed for iodine contrast agent,and acute,later and very late allergic reaction rates,clinical characteristics and corresponding treatments were summarized.RESULTS The clinical applications of 7 iodine contrast agents were different.Totally 128 ADRs of iodine contrast agent were observed,including 94 acute ADRs,31 late ADRs,and 3 very late ADRs,all the incidence rates were in the normal range.Of these ADRs,83（64.8%）occurred as skin allergy,19（14.8%）as gastrointestinal reactions,17（13.2%）in respiratory system,4（3.1%）in cardiovascular system,3（2.3%）in central nervous system,1（0.7%）in urinary system,1（0.7）in multiple system resulting death.Multivariate logistic regression analysis showed that age（OR=0.96,P=0.021）,heating before use（OR=1.74,P=0.028）,injecting velocity（OR=1.28,P=0.001）,scanning site（OR=0.73,P=0.041）are independent risk factors for adverse reactions.CONCLUSION Age,heating before use,injection velocity and scanning site are independent risk factors for adverse effects of non-ionic iodinated contrast agents.The correct and rational use of iodine contrast agent can provide the best means for the diagnosis of patients with disease and effectively reduce the incidence of adverse reactions,and improve the awareness of medical workers to deal with adverse reactions of iodine contrast agent.