Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2016 Apr;45(4):157-64.
Iodinated radiocontrast media (IRCM) is widely used in current clinical practice. Although IRCM is generally safe, serious adverse drug reactions (ADRs) may still occur. IRCM-induced ADRs may be subdivided into chemotoxic and hypersensitivity reactions. Several factors have been shown to be associated with an increased risk of ADRs, including previous contrast media reactions, history of asthma and allergic disease, etc. Contrast media with lower osmolality is generally recommended for at-risk patients to prevent ADRs. Current premedication prophylaxis in at-risk patients may reduce the risk of ADRs. However, there is still a lack of consensus on the prophylactic role of premedication. Contrast-induced nephropathy (CIN) is another component of IRCM-related ADRs. Hydration remains the mainstay of CIN prophylaxis in at-risk patients. Despite several preventive measures, ADRs may still occur. Treatment strategies for potential contrast reactions are also summarised in this article. This article summarises the pathophysiology, epidemiology and risk factors of ADRs with emphasis on prevention and treatment strategies. This will allow readers to understand the rationale behind appropriate patient preparation for diagnostic imaging involving IRCM.
碘造影剂（IRCM）在当前的临床实践中被广泛应用。尽管 IRCM 通常是安全的，但仍可能发生严重的药物不良反应（ADR）。IRCM 引起的 ADR 可分为化学毒性反应和过敏反应。有几个因素已被证明与 ADR 风险增加有关，包括先前的造影剂反应、哮喘和过敏病史等。对于高危患者，一般建议使用低渗透压造影剂以预防 ADR。目前，对于高危患者的预防性用药可能会降低 ADR 的风险。然而，关于预防性用药的作用仍存在争议。造影剂肾病（CIN）是 IRCM 相关 ADR 的另一个组成部分。在高危患者中，水化仍然是 CIN 预防的主要方法。尽管采取了多种预防措施，ADR 仍可能发生。本文还总结了潜在对比反应的治疗策略。本文总结了 ADR 的病理生理学、流行病学和危险因素，重点介绍了预防和治疗策略。这将使读者了解在涉及 IRCM 的诊断成像中对患者进行适当准备的基本原理。
