Gavant M L
Department of Diagnostic Radiology, University of Tennessee-Memphis College of Medicine 38163.
Invest Radiol. 1993 Nov;28 Suppl 5:S13-9; discussion S20. doi: 10.1097/00004424-199311001-00005.
The author reviews the clinical, ethical, medicolegal, and economic consequences of the routine versus limited use of low-osmolar contrast media for patients undergoing urographic and other radiologic studies.
A comprehensive review of the literature since the introduction of low-osmolar contrast media was conducted, focussing on medical decision making and the economic impact of those decisions on radiologic studies requiring the administration of water-soluble contrast agents.
Compared with high-osmolar ionic contrast media, routine use of low-osmolar agents for intravascular injection during diagnostic imaging results in fewer idiosyncratic reactions in patients and potentially less renal injury in a subgroup of critically ill patients. The high cost of low-osmolar agents relative to the overall cost of the examination has prevented the universal adoption of this class of agents in the United States.
Economic pressures on private and government-based insurance plans, as well as on managed-care systems responsible for a variety of patient populations, continue to limit the availability of low-osmolar agents to the individual patient.
作者回顾了在进行尿路造影及其他放射学检查的患者中，常规使用与限量使用低渗造影剂的临床、伦理、法医学及经济后果。
对自低渗造影剂引入以来的文献进行全面回顾，重点关注医疗决策以及这些决策对需要使用水溶性造影剂的放射学检查的经济影响。
与高渗离子型造影剂相比，在诊断成像期间常规使用低渗剂进行血管内注射，患者发生特异反应的情况较少，并且在一组重症患者中潜在的肾损伤也较少。相对于检查的总成本而言，低渗剂成本高昂，这阻碍了此类药剂在美国的普遍应用。
来自私人和政府保险计划以及负责各类患者群体的管理式医疗系统的经济压力，继续限制了低渗剂对个体患者的可及性。
