Jynge P
Department of Physiology and Biomedical Engineering, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Eur Radiol. 1996;6 Suppl 2:S8-12. doi: 10.1007/BF02342565.
The present short review describes the physiological effects of rapid transient changes in cardiac extracellular ions (electrolytes) caused by the bolus of x-ray contrast medium (CM) during coronary angiography. The underlying hypothesis is that as the molecular and osmolal toxicities of modern CM is low, cardiac side-effects result mainly from secondary and biphasic ionic changes which occur during the initial washout phase and during the later reintroduction of blood. In particular, the washout pattern for sodium (Na) and calcium (Ca) has great influence on cardiac function. Thus the Na-Ca exchange system of the cardiac cell membrane plays a pivotal role in controlling intracellular Ca and contractility during very brief coronary bolus injections of both nonionic and ionic CM. The nonionic dimeriodixanol is hyposmolal without an additive. Animal experiments demonstrate the value of taking myocardial Na-Ca relationships into careful consideration when adding ions to iodixanol and formulating an isotonic CM like Visipaque.
本简短综述描述了冠状动脉造影期间大剂量注射X射线造影剂（CM）导致心脏细胞外离子（电解质）快速短暂变化的生理效应。潜在的假设是，由于现代CM的分子毒性和渗透压毒性较低，心脏副作用主要源于初始冲洗阶段和后期血液重新引入期间发生的继发性和双相离子变化。特别是，钠（Na）和钙（Ca）的冲洗模式对心脏功能有很大影响。因此，在非离子型和离子型CM的冠状动脉快速推注期间，心肌细胞膜的Na-Ca交换系统在控制细胞内Ca和收缩力方面起着关键作用。非离子二聚体碘克沙醇不加添加剂时为低渗性。动物实验表明，在向碘克沙醇中添加离子并配制像威视派克这样的等渗CM时，仔细考虑心肌Na-Ca关系具有重要意义。
