急诊科类似过敏的对比反应：发生率、处理方法以及对患者处置的影响。

Allergic-like contrast reactions in the ED: Incidence, management, and impact on patient disposition.

机构信息

Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States.

出版信息

Am J Emerg Med. 2018 May;36(5):825-828. doi: 10.1016/j.ajem.2017.10.032. Epub 2017 Oct 12.

DOI:10.1016/j.ajem.2017.10.032

PMID:29079375

Abstract

PURPOSE

Determine the incidence, management, and impact on patient disposition of allergic-like contrast reactions (ALCR) to intravenous iodinated contrast in the emergency department (ED).

METHODS

All ED patients who developed an ALCR following contrast-enhanced CT (CECT) from June 2011-December 2016 were retrospectively identified. Medical records were reviewed and reaction severity, management, and disposition were quantified using descriptive statistics. The total number of consecutive CECTs performed in the ED were available from June 2011-March 2016 and were used to derive ALCR incidence over that time period.

RESULTS

A total of 90 patients developed an ALCR during the study period. An ALCR incidence of 0.2% was derived based on 74 ALCRs occurring out of 47,059 consecutive contrast injections in ED patients from June 2011-April 2016. Reaction severity was mild in 63/90 (70%) and moderate in 27/90 (30%) cases; no patient developed a severe reaction by American College of Radiology criteria. The most commonly administered treatments were diphenhydramine in 67/90 (74%), corticosteroid in 24/90 (27%), and epinephrine in 13/90 (14%); symptoms subsequently resolved in all cases. No patient required inpatient admission for contrast reaction alone, and 5 patients were sent to the ED observation unit for post-epinephrine monitoring and subsequently discharged.

CONCLUSION

ALCR among ED patients undergoing CECT are rare, generally of mild severity, respond well to pharmacologic management, and do not alter patient disposition in most cases. Familiarity with symptoms, management, and prevention strategies is increasingly relevant to the emergency physician given the ubiquity of CECT.

摘要

目的

确定急诊（ED）中静脉碘造影剂（CECT）后发生过敏样造影剂反应（ALCR）的发生率、处理方法和对患者处置的影响。

方法

回顾性分析 2011 年 6 月至 2016 年 12 月期间接受 CECT 后发生 ALCR 的所有 ED 患者。审查病历，使用描述性统计方法量化反应严重程度、处理方法和处置情况。2011 年 6 月至 2016 年 3 月期间 ED 连续进行的 CECT 总数可用于计算该时间段内的 ALCR 发生率。

结果

研究期间共有 90 例患者发生 ALCR。基于 2011 年 6 月至 2016 年 4 月期间 ED 患者 47059 例连续造影剂注射中发生的 74 例 ALCR，得出 ALCR 的发生率为 0.2%。63/90（70%）例患者的反应严重程度为轻度，27/90（30%）例患者的反应严重程度为中度；根据美国放射学院标准，无患者发生严重反应。最常使用的治疗方法是 67/90（74%）例患者使用苯海拉明、24/90（27%）例患者使用皮质类固醇、13/90（14%）例患者使用肾上腺素；所有患者的症状随后均得到缓解。没有患者因造影剂反应而单独住院，5 例患者被送往 ED 观察室进行肾上腺素监测，随后出院。