碘普罗胺冠状动脉造影对冠心病患者肾功能的影响

目的:观察分析非离子造影剂碘普罗胺(优维显)冠脉造影对冠心病患者肾功能的影响。方法:尿白蛋白、尿β2-微球蛋白(β2-microglobulin.β2-MG)、血β2-MG、尿素氮、肌酐含量正常的冠心病患者40例行碘普罗胺冠状动脉造影术,术后24小时复查尿白蛋白、尿β2-MG、血β2-MG,尿素氮、肌酐含量。结果:碘普罗胺冠状动脉造影术后24小时尿白蛋白、血β2-MG,尿素氮、肌酐含量无明显变化(P>0.05),尿β2-MG变化有显著意义(P<0.05)。结论:碘普罗胺冠脉造影使冠心病患者尿β2-MG水平明显升高.对肾小管重吸收功能有一定的损害。     

碘普罗胺对冠状动脉造影时中心动脉压的影响

碘普罗胺(优维显)是一种常用造影剂,临床应用广泛.为了对其合理应用提供科学理论依据,我们在选择性冠状动脉造影中用碘普罗胺作为造影剂,观察了造影前后中心动脉压的变化,以了解其对心脏及血压的影响.     

冠状动脉介入术中碘普罗胺致过敏性休克1例

1病例报告 　　病人女,65岁.因反复胸痛1周诊断为急性冠状动脉综合征2003-08-01入院.7 d后行冠状动脉造影.既往无药物及食物过敏史.术前1 d碘过敏试验(静脉注射法)阴性.术前半小时予地西泮5 mg口服.Seldinger法穿刺右股动脉,2%利多卡因局部浸润麻醉皮肤.造影剂为碘普罗胺(iopromide)370. 　　……     

克林霉素致迟发性过敏反应3例

例1，患者，男，69岁。因腿部切割伤2h，于2002年10月4日入院。入院后给予清创缝合后，应用克林霉素200ml(1．2g)静脉输液qd，8天后拆线，伤口愈合好，无感染，停输液。患者逐渐感皮肤瘙痒，查体见有红色皮疹，高出皮面，有喉紧、喉痒感，皮疹逐渐增多、增大连成片状，最后延及口腔、舌面。出现皮疹后立即给予50％GS20ml 加葡萄糖酸钙1g静推，5％GS500ml 葡萄糖酸钙1g 地塞米松10mg静滴qd，过敏症状明显好转，5天后治愈出院。     

青霉素致迟发性肠道过敏反应1例

青霉素是一种临床治疗中广泛应用的广谱抗生素 ,其引起迟发性肠道过敏反应者少见。现报告 1例。患者男 ,37岁 ,因感冒发热于 2 0 0 2年 4月 16日来本院门诊治疗 ,拟静滴青霉素。青霉素皮试阴性 ,即予以生理盐水2 5 0 ml加青霉素 4 80万 U静滴 ,连用 3天 ,患者热退 ,无不良反应。第 4天患者再次静滴约 10分钟 ,突然出现腹部疼痛 ,面色苍白 ,两侧肾区绞痛 ,同时呕吐 ,继之四肢发凉 ,大汗淋漓。当即中断输液 ,测患者脉搏微弱 ,血压 9/ 6 k Pa。立即皮下注射 0 .1%盐酸肾上腺素 1mg,同时静注地塞米松5 mg,肌注非那根 2 5 mg,随后静滴维生素 C3…     

维生素B6致迟发性过敏反应一例

患者男 ,42岁。因外伤致左肩锁关节陈旧性脱位而住院。手术后给予 0 9%氯化钠注射液 50 0ml+头孢噻肟钠5 0 g ,5 %葡萄糖注射液 50 0ml+维生素C 2 0 g +维生素B60 2 g静滴。连续用药至第 4天 ,静滴第 2组液体约 1 5min自诉突然全身发冷。体检 :神志清楚 ,双瞳孔等大等圆 ,血压 1 1 4 / 76mmHg(1kPa =7.5mmHg) ,口唇轻度发绀 ,全身寒战 ,四肢厥冷 ,双肺呼吸音粗 ,未闻及干湿性音 ,心率 70次 /min ,腹部无异常。给予停药 ,吸氧 ,异丙嗪 2 5mg肌注等治疗 ,2 0min后症状消失 ,随后体温升至 38 6℃ ,4h后降至正常。第 5天再次用药过程中又…     

润滑止痛胶发生迟发性过敏反应一例

患者女,50岁,因反复中上腹胀痛不适伴嗳气1年,加重1周入我科行胃镜检查。患者一般情况尚可,检查前询问无过敏史,将约3g润滑止痛胶(相当于盐酸丁卡因0.03g)滴于患者舌根部进行咽部表面麻醉,2min后无任何不适,即行胃镜检查。操作过程顺利,患者安静配合,检查完毕患者情况良好。离院途中,患者突然大汗淋漓、心慌、胸闷、呼吸困难,胸部及双臂出现大小不等的风团,即被家属扶回我科。     

冠状动脉造影及介入术后造影剂迟发型过敏反应的护理效果评价

目的探讨冠状动脉造影及介入术后造影剂迟发型过敏反应的护理效果。方法将2018年1月至2019年12月在我院接受冠状动脉造影及介入术的120例冠心病患者随机分为两组,各60例。对照组实施常规护理,观察组实施预见性护理,比较造影剂迟发型过敏反应发生率、舒适度评分、不良情绪评分、护理满意度。结果观察组造影剂迟发型过敏反应发生率3.33%低于对照组15.00%(P0.05)。护理后,与对照组相比,观察组舒适度评分增高,SAS和SDS评分均降低(P0.05)。护理总满意率观察组、对照组分别为96.67%、83.33%,观察组更高(P0.05)。结论在冠状动脉造影及冠状动脉介入术患者中实施预见性护理,可降低造影剂迟发型过敏反应风险。     

冠状动脉造影正常的再发性心肌梗塞

患者,男,30岁。1987年3月21日入院。1986年9月13日发生心前区压榨样剧痛,持续20多分钟后,心电图证实为急性前侧壁心肌梗塞,经治疗好转。病后一个月,在心前区闷胀不适时心电图显示ST段抬高。入院时心电图为陈旧性前侧壁心肌梗塞(图1:A1987年3月23日)。入院后行左室及冠状动脉造影:发现左室心尖段活动减弱,未见室壁瘤。左冠状动脉     

静脉滴注胺碘酮致过敏反应一例

患者女性，62岁。因阵发心悸、胸闷9年，再发1h，于2004年11月5日就诊。既往史：风湿性心脏瓣膜病、二尖瓣狭窄30余年，9年来反复出现阵发性心房颤动，曾多次应用西地兰、普罗帕酮等药物复律治疗，平时口服普罗帕酮150mg 3次／d、地高辛0．125mg 1次／d、美托洛尔12．5mg 2次／d等药物治疗。自述肌肉注射青霉素后有皮疹病史。入院查体：血压137／88mmHg，意识清楚，两肺呼吸音清，未闻及干湿性哕音，心率140～168次／min，律不齐，心尖部可闻及Ⅱ级舒张期杂音，     

Delayed allergic reaction after coronary angiography

Contrast-enhanced angiography is a very useful tool for the diagnosis and evaluation of vascular diseases. Contrast media (CM) were first introduced in the 1930s and since then they have become an important diagnostic method. Nonetheless, using CM have their price, as some patients may develop adverse reactions to them. These reactions to CM are divided into chemotoxic and allergic/pseudoallergic. Both reactions range in their time of appearance, clinical manifestations, severity, pathomechanisim, diagnostic methods and the way they are managed. Late adverse reactions to CM may be easily overlooked as they are less reported. In the present case report, the authors present a patient who developed a delayed response to nonionic CM used during an elective coronary angiography, followed by a review of the current literature and suggested recommendations.     

Reflex vasodilation induced by coronary angiography in human subjects.

In order to evaluate the reflex peripheral vascular effects of coronary arteriography, forearm blood flow was measured plethysmographically and forearm vascular resistance calculated before and during coronary angiography with Hypaque-M, 75%, and Renografin-76. The injection of Hypaque into the left coronary artery resulted in a forearm vasodilation which could not be duplicated by an injection of a comparable amount of contrast into the ascending aorta, three centimeters above the coronary ostia. Forearm blood flow rose from 2.95 to 5.41 ml/min/100 ml (83.4%) and forearm vascular resistance fell from 35.8 to 19.9 mm Hg/ml/min/100 ml (44.4%). Renografin injected into the left coronary artery resulted in less forearm vasodilation (21% increase in forearm blood flow and 32% decrease in forearm vascular resistance). When coronary arteriography was repeated following injection of atropine into the brachial artery, no forearm vasodilation occurred. It is suggested that in human subjects myocardial or coronary artery receptors can be activated by the intracoronary injection of iodinated contrast media which results in a forearm vasodilation.     

Contrast-induced neurotoxicity after coronary angiography

Background

Contrast-induced neurotoxicity (CIN) is a very rare complication of coronary angiography. Clinical presentations include encephalopathy, seizures, cortical blindness, and focal neurological deficits. An inherent difficulty in understanding the natural history of the condition as well as its risk factors and prognosis is the rarity of its occurrence. To date, there are only case reports published on this complication.

Patients and methods

This was a retrospective analysis of 9 patients with CIN (8 men, 1 woman; mean age, 64.6?±?7.8 years; range, 47–72 years) and coronary artery disease who were administered iopromide contrast agent.

Results

In the last 3 years, we diagnosed 9 patients with CIN. Of these, 8 patients (89?%) had hypertension. The clinical presentations of the patients were different on admission: 6 patients had acute coronary syndrome and 3 patients had stable angina pectoris. One patient had history of previous contrast agent exposure. All patients underwent coronary angiography with a low-osmolar nonionic monomer contrast agent (iopromide; Ultravist®-300, Bayer Healthcare). The mean volume of contrast injected was 177?±?58 ml. The mean time between contrast agent administration and clinical symptoms was 100?±?71 min (range, 30–240 min). While in 5 of the patients (56?%) the clinical sign of CIN was confusion, 2 had ophthalmoplegia, 1 had cerebellar dysfunction, and 1 had monoplegia. In 8 of 9 patients (89?%), neurological symptoms resolved after giving supportive medication and hydration. Only 1 female patient, who had bilateral ophthalmoplegia, did not recover. Neurological recovery occurred at a mean time of 14.2?±?6.7 h (range, 8–30 h).

Conclusion

CIN is a very rare condition. Advanced age, male gender, and hypertension are the greatest risk factors for CIN. Although the prognosis of CIN is benign, it can potentially cause permanent neurological deficits or death. We found that patients with ophthalmic involvement had a higher propensity for persistent deficit. On the basis of the current data, we propose 170 ml as the maximal recommended dose for coronary procedures.     

Trash feet after coronary angiography

Cholesterol crystal embolisation is a frequently underdiagnosed condition. While coronary catheterisation is safe and commonly performed, the reported patient developed very painful trash feet after undergoing this routine procedure. Ulceration and gangrene occurred after catheter manipulation during cardiac angiography, which caused occlusion of the small arteries in his feet. The triad of pain, livedo reticularis, and intact peripheral pulses is pathognomonic for cholesterol embolisation. The prognosis depends on the extent of the systemic disease and a high rate of mortality (75-80%) is observed. Prognosis is poor and the treatment is only supportive. It is suggested that while cardiac catheterisation is largely safe and a very commonly performed procedure, it can still lead to complications with serious side effects and can even prove fatal.     

Quantitative angiography after directional coronary atherectomy

OBJECTIVE--To assess by quantitative analysis the immediate angiographic results of directional coronary atherectomy. To compare the effects of successful atherectomy with those of successful balloon dilatation in a series of patients with matched lesions. DESIGN--Case series. SETTING--Tertiary referral centre. PATIENTS--62 patients in whom directional coronary atherectomy was attempted between 7 September 1989 and 31 December 1990. INTERVENTIONS--Directional coronary atherectomy. MAIN OUTCOME MEASURES--Increase in minimal luminal diameter of coronary artery segment. RESULTS--Angiographic success on the basis of intention to treat was obtained in 54 patients (87%). In four patients the lesion could not be crossed by the atherectomy device; all four had an uneventful conventional balloon angioplasty. Four of the 58 patients who underwent atherectomy were subsequently referred for coronary bypass surgery because of failure or complications; three of them sustained a transmural infarction. In the successful cases, coronary atherectomy resulted in an increase in the minimal luminal diameter from 1.1 mm to 2.5 mm with a concomitant decrease of the diameter stenosis from 62% to 22%. In the subset of 37 patients in which the changes induced were compared with conventional balloon angioplasty atherectomy increased the minimal luminal diameter more than balloon angioplasty (1.6 v 0.8 mm; p less than 0.0001). Conventional histology showed media or adventitia in 26% of the atherectomy specimens. In hospital complications occurred in six patients who had undergone a successful procedure: two transmural infarctions, two subendocardial infarctions, one transient ischaemia attack, and one death due to delayed rupture of the atherectomised vessel. All patients were clinically evaluated at one and six months. One patient had persisting angina (New York Heart Association class II), one patient sustained a myocardial infarction, one patient underwent a percutaneous transluminal coronary angioplasty for early restenosis, and one patient underwent coronary bypass surgery because of a coronary aneurysm formation. At six months 80% (36/47) of the patients were symptom free. CONCLUSIONS--Coronary atherectomy achieved a better immediate angiographic result than balloon angioplasty; however, in view of the complication rate in this preliminary series, which may be related to a learning curve, a randomised study is needed to show whether this procedure is as safe as a conventional balloon angioplasty.     

Enzyme changes after coronary angiography.

The enzymatic response to contrast media after coronary angiography was observed in 24 patients. The enzymes studied were glutamic oxaloacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), lactic dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), gamma-glutamyl transferase (gamma-GT), creatine phosphokinase (CPK), and the myocardial-specific isoenzyme of CPK (CK-MB). Angiography produced no significant elevations in SGOT, SGPT, alpha-HBDH, LDH, or CK-MB activities; gamma-GT increased up to the twelfth hour. High levels of CPK and CK-MB observed in one patient were found to be products of a thymus carcinoma. In vitro examinations also showed that concentrations of contrast media used in coronary angiography do not inhibit gamma-GT, LDH, and CPK activities.