Debatin J F, Cohan R H, Leder R A, Zakrzewski C B, Dunnick N R
Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710.
Invest Radiol. 1991 Jan;26(1):17-21. doi: 10.1097/00004424-199101000-00004.
Two thousand thirty-four consecutive patients presented for excretory urography within a 22-month period. Of 57 observed adverse reactions (incidence 2.8%), 54 occurred in 1219 low-risk patients injected with conventional ionic contrast media (HOCM) (incidence 4.4%) while three reactions were noted in the 815 high-risk patients receiving low-osmolar contrast media (LOCM) (incidence 0.4%). Despite strict enforcement of an unchanging list of high-risk criteria by the same pool of radiologists, LOCM use was not constant, increasing in use over time from 26.5% to 55.3% of urograms. In addition, frequency of LOCM selection increased transiently (from 33% to 52%) following a single life-threatening reaction to HOCM. Our results suggest that strict guidelines for use of LOCM are subject to loose individual physician interpretation. Physicians' perceptions of safety made it increasingly difficult to withhold LOCM and progressively more patients were included in high-risk groups.
在22个月的时间里，2034例患者连续接受排泄性尿路造影检查。在观察到的57例不良反应中（发生率2.8%），54例发生在1219例注射传统离子型造影剂（HOCM）的低风险患者中（发生率4.4%），而在815例接受低渗造影剂（LOCM）的高风险患者中观察到3例不良反应（发生率0.4%）。尽管同一批放射科医生严格执行不变的高风险标准清单，但LOCM的使用并不稳定，随着时间的推移，其在尿路造影中的使用比例从26.5%增加到55.3%。此外，在发生一例危及生命的HOCM不良反应后，LOCM的选择频率短暂增加（从33%增至52%）。我们的结果表明，关于使用LOCM的严格指南在个体医生的解释上较为宽松。医生对安全性的认知使得拒绝使用LOCM变得越来越困难，越来越多的患者被纳入高风险组。
