Morissette M, Gagnon R M, Lamoureux J, Lemire J
Am Heart J. 1980 Sep;100(3):319-22. doi: 10.1016/0002-8703(80)90145-3.
Angiographic contrast media are known to induce alterations in cardiovascular dynamics which may result in acute pulmonary edema. The risk of pulmonary edema was previously shown to be negatively correlated to the level of colloid oncotic pressure (COP). It was also shown that the gradient between COP and left ventricular end-diastolic pressure (LVEDP) represents a better predictor of pulmonary edema than does LVEDP alone. The present report evaluates the effects of a bolus injection of contrast media on those pressures, as predisposing factors for pulmonary edema. Our data are based on 15 unselected patients admitted for coronary angiography. The plasma volume increased by 16.5% (2,903 to 3,384 ml.) at two minutes after injection of a 50 c.c. bolus of meglumine diatrizoate (Renographin 76%) and had returned towards normal at 30 minutes. In parallel the COP decreased from 23.4 +/- 2.4 to 19.6 +/- 2.3 mm. Hg (p < 0.001) to return the 22.7 +/- 2.6. The COP-LVEDP gradient decreased by 8.7 mm. Hg (8.4 to -0.3, P < 0.001). Such a gradient was well within the danger zone of pulmonary edema. These findings further clarify the mechanisms of pulmonary edema induced by contrast media.
血管造影剂已知会引起心血管动力学改变，这可能导致急性肺水肿。先前已表明肺水肿的风险与胶体渗透压（COP）水平呈负相关。还表明，COP与左心室舒张末期压力（LVEDP）之间的梯度比单独的LVEDP更能预测肺水肿。本报告评估了推注造影剂对这些压力的影响，这些压力是肺水肿的诱发因素。我们的数据基于15例因冠状动脉造影而入院的未经选择的患者。注射50毫升泛影葡胺（Renographin 76%）推注后两分钟，血浆量增加了16.5%（从2903毫升增至3384毫升），并在30分钟时恢复至正常。与此同时，COP从23.4±2.4降至19.6±2.3毫米汞柱（p<0.001），并恢复至22.7±2.6。COP-LVEDP梯度下降了8.7毫米汞柱（从8.4降至-0.3，P<0.001）。这样的梯度完全处于肺水肿的危险范围内。这些发现进一步阐明了造影剂诱发肺水肿的机制。
