Brinker J A
Cardiac Catheterization Laboratory, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Am J Cardiol. 1990 Oct 26;66(14):26F-33F. doi: 10.1016/0002-9149(90)90638-h.
The evolution of contrast material for intravascular use has been directed toward the development of better-tolerated agents. Currently, a variety of such "dyes" are available for coronary angiography and left ventriculography. Considerable animal and human investigation suggests that significant differences exist between the families of contrast agents that relate to patient tolerance. The newer low osmolality agents (especially the nonionic agents) produce less perturbation of the homeostatic state, which is clinically manifested by a lessened incidence of side effects, including those of a hemodynamic and electrophysiologic nature. While controversy continues over the cost/benefit ratio of the low osmolality contrast agents compared to traditional high osmolality agents, the former are rapidly becoming the community standard for diagnostic and especially therapeutic cardiologic procedures. Accepting the advantages of the low osmolality contrast agents, differences between the ionic dimers and the nonionic agents have been examined. Both experimental and clinical data suggest superiority of the nonionic agents. Although controversy still surrounds the issue of thromboembolism with the nonionic agents, accumulating evidence fails to support a clinically significant relation. The choice of contrast material is the responsibility of the invasive cardiologist. While the benefits of low osmolality agents are most obvious in high-risk patients, experience with large-scale intravenous studies suggests that the choice of contrast agent is a better discriminator of adverse reaction than is preprocedural risk stratification.
血管内使用的造影剂的发展方向是研发耐受性更好的制剂。目前，有多种此类“染料”可用于冠状动脉造影和左心室造影。大量的动物和人体研究表明，不同类别的造影剂在患者耐受性方面存在显著差异。新型低渗制剂（尤其是非离子型制剂）对体内稳态的干扰较小，其临床表现在于副作用（包括血液动力学和电生理性质的副作用）的发生率降低。尽管与传统高渗造影剂相比，低渗造影剂的成本效益比仍存在争议，但前者正迅速成为诊断尤其是治疗性心脏检查的行业标准。在认可低渗造影剂优点的同时，人们也对离子二聚体和非离子型制剂之间的差异进行了研究。实验和临床数据均表明非离子型制剂更具优势。尽管非离子型制剂的血栓栓塞问题仍存在争议，但越来越多的证据并不支持其与临床显著相关。造影剂的选择由介入心脏病专家负责。虽然低渗制剂的益处在高危患者中最为明显，但大规模静脉注射研究的经验表明，造影剂的选择比术前风险分层更能区分不良反应。
