三种非离子型碘对比剂用于冠状动脉介入治疗致过敏反应发生情况的比较分析

来源 :药物不良反应杂志 | 被引量 : 0次 | 上传用户:fsdafdsfsdsdf
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目的:比较3种非离子型碘对比剂(NICM)用于经皮冠状动脉介入治疗(PCI)致过敏反应的发生情况及临床特点。方法:从北京安贞医院2013年1月1日至2018年12月31日的药物不良反应报表中筛选出因PCI手术中应用碘海醇、碘普罗胺或碘克沙醇发生过敏反应的患者,并通过检索医院信息系统获取同期行PCI手术且术中应用上述NICM的患者总数。计算3种NICM总体和各自的过敏反应、严重过敏反应发生率,并分析其临床特点。结果:3种NICM的总体过敏反应发生率为0.603%(422/69 955),严重过敏反应发生率为0.024%(17/69 955)。碘海醇、碘普罗胺和碘克沙醇过敏反应发生率分别为0.418%(109/26 097)、0.364%(83/22 787)和1.092%(230/21 071),严重过敏反应发生率分别为0.023%(6/26 097)、0.039%(9/22 787)和0.009%(2/21 071)。碘克沙醇过敏反应发生率高于碘普罗胺和碘海醇(均n P1 h)者246例(66.0%)。碘普罗胺导致的过敏反应以速发型为主(79.5%,62/78),而碘克沙醇以迟发型为主(87.7%,193/220)。速发型过敏反应患者既往有过敏史者占比明显高于迟发型患者[15.0%(15/100)比7.1%(14/197),n P=0.030]。过敏反应的临床表现以皮疹最为常见[78.0%(329/422)],严重过敏反应17例中过敏性休克15例(88.2%),喉头水肿和呼吸困难各1例,均为速发型。过敏反应经治疗均好转,但有6例患者因严重过敏反应未能完成PCI手术。n 结论:3种NICM用于PCI的安全性均较好,过敏反应发生率低,其中碘普罗胺的严重过敏反应发生率最高。过敏性休克等严重过敏反应会影响PCI手术的进行,应予警惕。“,”Objective:To compare the occurrence and clinical characteristics of hypersensitivity reactions induced by 3 non-ionic iodine contrast media (NICMs) during percutaneous coronary intervention (PCI).Methods:The patients who developed hypersensitivity reactions in iopromide, iohexol, and iodixanol application during PCI were screened out from adverse drug reaction reports of Beijing Anzhen Hospital from January 1, 2013 to December 31, 2018 and the total number of patients who underwent the PCI during that period and received the above NICMs was obtained by searching the hospital information system. The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions and incidences of those induced by each of the 3 NICMs were calculated and their clinical characteristics were analyzed.Results:The overall incidences of hypersensitivity reactions and severe hypersensitivity reactions induced by the 3 NICMs were 0.603% (422/69 955) and 0.024% (17/69 955). The incidences of hypersensitivity reactions induced by iohexol, iopromide, and iodixanol were 0.418% (109/26 097), 0.364% (83/22 787), and 1.092% (230/ 21 071), respectively; the incidences of severe hypersensitivity reactions were 0.023% (6/26 097), 0.039% (9/22 787), and 0.009% (2/21 071), respectively. Iodixanol had a higher incidence of hypersensitivity reactions than iopromide and iohexol (both n P1 hour) in 246 patients (66.0%). The hypersensitivity reactions induced by iopromide were mainly immediate type (79.5%, 62/78), while those induced by ioxamol were mainly delayed type (87.7%, 193/220). The proportion of patients with a previous history of allergy in the immediate type patients was significantly higher than that in the delayed type patients [15.0% (15/100)n vs. 7.1% (14/197), n P=0.030]. The most common clinical manifestation of hypersensitivity reactions was rash [78.0% (329/422)]. Among 17 cases of severe hypersensitivity reactions, 15 (88.2%) were anaphylactic shock, 1 was laryngeal edema, and 1 was dyspnea, all of which were immediate type. Hypersensitivity reactions were all improved after treatments, but PCI failed to be fully performed in 6 patients due to severe hypersensitivity reactions.n Conclusions:The safety of 3 NICMs for PCI was good and the incidence of hypersensitivity reactions was low; the incidence of severe hypersensitivity reactions due to iopromide was the highest. Severe hypersensitivity reactions such as anaphylactic shock might affect the performance of PCI and caution should be given.
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