四种钆对比剂不良反应相关因素分析及处理方式

Analysis and treatment of adverse reactions associated with four gadolinium contrast agents

目的:探讨四种钆对比剂临床应用中的不良反应(ADR)相关因素及最佳处理方式。方法:通过比较对比剂特性、患者体质、诊疗类型、对比剂应用情况、增强前基础用药史及发生ADR情况(钆对比剂渗透压、注射后血液中存在形式、排泄途径;患者的年龄、性别、用药剂量、推注方式、增强时间、增强部位; ADR反应时间、严重程度、治疗后转归),综合分析对比剂不良反应发生相关因素,总结对比剂所致急性、晚发性及超晚发性ADR发生率、发生特点及相应临床处理方法。结果:患者的年龄、注射流速、增强前基础用药、扫描部位是钆对比剂ADR的独立危险因素;线性离子型对比剂发生ADR最高;各系统症状及不同级别ADR严格对症处理;各个系统中均以急性皮肤症状最常见,无需特殊处理痊愈率较高,晚发性或超晚发性患者需给予抗组胺类或糖皮质激素药物治疗;我院随访4年内应用多次大剂量对比剂增强患者均未发现肾源性系统性纤维化(NSF)及齿状核、双肺、胸膜等部位钆沉积征象。结论:环状对比剂相对发生ADR较少;患者增强前有基础用药史(糖尿病、变应性鼻炎、肿瘤病史)、增强时采取大剂量缓慢推注的体质量轻的中年门诊患者发生急性轻度ADR最高;影像科医务工作者应熟练掌握合理ADR的处理方法,合理使用对比剂能够有效的降低不良反应发生率。

AIM： To discuss the factors related to the adverse reaction （ADR） in the clinical appli- cation of four gadolinium contrast agents and the best way to deal with it. METHODS： The characteris- tics of the contrast agent, the patient＇s constitution, the diagnosis and treatment, the application of contrast agent, the history of pre-enhanced basic medi- cation and the occurrence of ADR （gadolinium con- trast agent osmotic pressure, the form of the blood in the blood after the injection, the way of excretion, the patient＇s age, sex, dosage, injection, enhance- ment time, enhanced site; ADR reaction time, se- verity, treatment after treatment） were compared to comprehensively analyze the contrast agent adverse reaction factors, summary of contrast agent induced acute, late onset and ultra late onset ADR inci dence, occurrence characteristics and corresponding clinical treatment methods. RESULTS：Age, injec tion velocity, pre-enhanced base medication and scanning site were independent risk factors for gadolinium contrast agent ADR; linear ionic specific a- gent had the highest ADR; the symptoms of various systems and different levels of ADR were strictlysymptomatic; all the systems were most common with acute skin symptoms, without special treatment, high recovery rate, onset patients need to be late onset or super. Late treated with antihistamine or glucocorticoid, and no gadolinium deposits of NSF, dentate nucleus, double lung, and pleura were found in patients who had been enhanced with a number of large dose contrast agents within 4 years of follow-up. CONCLUSION： The relative incidence of ring-shaped contrast agents show less ADR, and the history of basic medication （ diabetes, allergic rhinitis, tumor History ） before the enhance- ment, and the middle-aged outpatient with large dose of slow weight and light weight when the enhancement is enhanced, have the highest acute mild ADR. The medical workers in the imaging department should master the reasonable ADR treatment, which can effectively reduce the incidence of adverse reactions.