Morcos Sameh K
Department of Diagnostic Imaging, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, United Kingdom.
J Vasc Interv Radiol. 2005 Jan;16(1):13-23. doi: 10.1097/01.RVI.0000145224.02920.C2.
Contrast medium-induced nephrotoxicity (ie, contrast nephrotoxicity [CN]) remains an important complication of angiographic procedures. If administration of iodinated contrast medium is deemed necessary in patients at high risk of CN, volume expansion should be offered and the lowest possible dose of nonionic isosmolar dimeric or nonionic low-osmolar monomeric contrast medium should be used. Prophylactic administration of fenoldopam or acetylcysteine has not offered consistent protection against CN. Intravenous acetylcysteine could be considered in emergency situations. Recently, sodium bicarbonate infusion has been shown to reduce the risk of CN. Hemofiltration for several hours before and after contrast medium injection may offer good protection against CN in patients with advanced renal disease. Prophylactic hemodialysis does not offer any protection against CN.
造影剂诱导的肾毒性（即造影剂肾病[CN]）仍然是血管造影术的一项重要并发症。对于发生CN高风险的患者，如果认为有必要给予碘化造影剂，则应进行容量扩充，并应使用最低可能剂量的非离子等渗二聚体或非离子低渗单体造影剂。预防性给予非诺多泮或乙酰半胱氨酸未能提供一致的针对CN的保护作用。在紧急情况下可考虑静脉给予乙酰半胱氨酸。最近，已证明输注碳酸氢钠可降低CN的风险。在注射造影剂前后进行数小时的血液滤过可能为晚期肾病患者提供良好的针对CN的保护作用。预防性血液透析不能提供针对CN的任何保护作用。
