Bisbe E, Escolano F, Díez A, Castaño J
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital de l'Esperança, Barcelona.
Rev Esp Anestesiol Reanim. 1990 May-Jun;37(3):156-9.
We report a patient with urinary sepsis who, during intravenous urography with iodinated contrast (70 mg Na, Ca diatrizoate and meglumine) developed dyspnea, tachypnea, sinus tachycardia and moderate hypoxemia (pO2: 72 with FiO2 of 0.21). She subsequently developed adult respiratory distress syndrome (ARDS) with refractory hypoxemia (pO2: 40 mmHg with FiO2 of 0.5) and disseminated intravascular coagulation (DIC) (prothrombin index: 5%, platelets: 20,000/mm3, APTT: 102/37 min, FDP: 80 ng/ml, and fibrinogen: 120 mg %). The patient required mechanical ventilation and treatment with inotropic drugs, antibiotics, corticosteroids, plasma, platelets and erythrocytes. The outcome was favorable, and she could be discharged from the Reanimation Service 7 days after admission. In severe systemic reactions to iodinated contrasts (SRIC), ARDS and DIC are common. In our patient, the close temporal association between the administration of iodinated contrast and the development of the clinical picture made us suspect their possible causal relation. A higher predisposition to SRIC in patients with sepsis has been reported. We review the SRIC in which the anesthesiologist may play a role for reanimation.
我们报告了一名患有尿源性脓毒症的患者，在静脉肾盂造影使用碘化造影剂（70mg钠、泛影葡胺钙和葡甲胺）期间出现呼吸困难、呼吸急促、窦性心动过速和中度低氧血症（pO2：72，吸入氧分数为0.21）。随后她发展为成人呼吸窘迫综合征（ARDS），伴有难治性低氧血症（pO2：40mmHg，吸入氧分数为0.5）和弥散性血管内凝血（DIC）（凝血酶原指数：5%，血小板：20,000/mm³，活化部分凝血活酶时间：102/37分钟，纤维蛋白降解产物：80ng/ml，纤维蛋白原：120mg%）。该患者需要机械通气以及使用强心药物、抗生素、皮质类固醇、血浆、血小板和红细胞进行治疗。结果良好，入院7天后她可以从复苏科出院。在对碘化造影剂的严重全身反应（SRIC）中，ARDS和DIC很常见。在我们的患者中，碘化造影剂给药与临床表现发展之间紧密的时间关联使我们怀疑它们可能存在因果关系。据报道，脓毒症患者对SRIC的易感性更高。我们回顾了麻醉医生在复苏中可能发挥作用的SRIC情况。
