Schräder R, Hellige G, Kaltenbach M, Kober G
Department of Cardiology, University of Frankfurt am Main, Medical School, F.R.G.
Eur Heart J. 1987 Dec;8(12):1322-31. doi: 10.1093/oxfordjournals.eurheartj.a062219.
The haemodynamic side-effects of ionic (amidotrizoate) and non-ionic (iopamidol) contrast media after injection into the right atrium were compared in experimental and clinical studies. Pulmonary hypertension was induced in 10 dogs by embolization of the pulmonary vascular bed with agar-agar solution (mean pulmonary artery pressure = 44.2 mmHg). Iopamidol (1.5 ml kg-1) caused a moderate decrease in pulmonary and systemic vascular resistance, slight increases in right ventricular end-diastolic pressure and a marked rise in right ventricular contractility (dP/dtmax). Amidotrizoate (1.5 ml kg-1) caused considerable systemic vasodilation and initial increases in pulmonary vascular resistance and pressure followed by a substantial increase in right ventricular end-diastolic pressure and a decrease in contractility. Central and peripheral haemodynamics were measured in 20 patients with pulmonary hypertension (mean pulmonary artery pressure = 38.1 mmHg) due to valvular heart disease before and following injections with 40 ml of both types of contrast medium in randomized order. Heart rate, cardiac output and right atrial pressure rose significantly more after amidotrizoate and this contrast medium caused more extensive systemic vasodilation and a larger decrease in aortic pressure as compared to iopamidol. Pulmonary artery pressure went up moderately with both contrast media. It is concluded that non-ionic low-osmolality contrast media like iopamidol induce less pronounced haemodynamic alterations, in particular less increase in right ventricular filling pressure. This may be beneficial to patients with pulmonary hypertension undergoing angiocardiography or digital subtraction angiography.
在实验和临床研究中，比较了离子型（泛影葡胺）和非离子型（碘帕醇）造影剂注入右心房后的血流动力学副作用。用琼脂溶液栓塞肺血管床诱导10只犬发生肺动脉高压（平均肺动脉压=44.2 mmHg）。碘帕醇（1.5 ml/kg）使肺血管阻力和体循环血管阻力适度降低，右心室舒张末期压力略有升高，右心室收缩力显著增强（dP/dtmax）。泛影葡胺（1.5 ml/kg）引起显著的体循环血管扩张，肺血管阻力和压力最初升高，随后右心室舒张末期压力大幅升高，收缩力下降。对20例因瓣膜性心脏病导致肺动脉高压（平均肺动脉压=38.1 mmHg）的患者，以随机顺序注射40 ml两种造影剂前后测量中心和外周血流动力学。与碘帕醇相比，注射泛影葡胺后心率、心输出量和右心房压力升高更为显著，且这种造影剂引起更广泛的体循环血管扩张和主动脉压力更大幅度的下降。两种造影剂均可使肺动脉压适度升高。结论是，像碘帕醇这样的非离子型低渗造影剂引起的血流动力学改变不那么明显，尤其是右心室充盈压升高较少。这可能对接受心血管造影或数字减影血管造影的肺动脉高压患者有益。
