2019 年第 7 期 第 14 卷

冠状动脉造影及介入术后造影剂迟发型过敏反应的观察和护理

Clinical observation and nursing of contrast media-induced delayed allergic reaction after coronary angiography and interventional therapy

作者：万宝艳陈霞罗子妹曾勇高瑞雪

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科一病房（万宝艳、陈霞、罗子妹、曾勇），护理部（高瑞雪）

英文单位：

关键词：冠状动脉造影；介入治疗；造影剂；迟发型过敏反应

英文关键词：

• 摘要：

• 【摘要】目的    探讨冠状动脉造影及介入术后造影剂引起的迟发型过敏反应的临床特点与护理措施。方法    收集2018年1月1日至2018年9月30日在首都医科大学附属北京安贞医院进行冠状动脉造影和/或介入治疗的2 611例患者的病历资料，分析术后造影剂迟发型过敏反应的临床特点，探讨其护理与治疗措施。结果    2 611例患者中出现迟发型过敏反应35例（1.3%），其中轻度25例、中度9例、重度1例。不同性别及年龄患者间迟发型过敏反应发生率比较，差异均无统计学意义（均P＞0.05）。25例轻度迟发型过敏反应以皮疹伴皮肤瘙痒为主要表现，9例中度过敏反应以眼睑、颜面部水肿为主要表现，1例重度过敏反应者表现为全身寒战及急性血压下降。2例患者仅口服氯雷他定治疗，33例患者使用了糖皮质激素，主要包括地塞米松以及甲泼尼龙。1例重度过敏反应患者开通新的静脉通路加强补液，给予氧气吸入，并使用了小剂量多巴胺维持血压。所有患者治疗后均安全出院。结论    不同性别及不同年龄间造影剂迟发型过敏反应发生率无明显差异。临床工作者应增强对迟发型过敏反应的重视程度，对于使用过造影剂的患者，应密切观察病情变化，认真听取并记录患者主诉，对过敏反应做到早发现、早干预。

• 【Abstract】Objective    To investigate the clinical features and nursing measures of contrast media-induced delayed allergic reaction after coronary angiography and interventional therapy. Methods    Clinical records of 2 611 patients who underwent coronary angiography and/or interventional therapy in Beijing Anzhen Hospital, Capital Medical University from January 1st, 2018 to September 30st, 2018 were collected. Clinical characteristics of delayed contrast media-induced allergic reaction, nursing and therapeutic measures were analyzed. Results    There were 35 patients（1.3%） having delayed contrast media-induced allergic reaction, including 25 cases of mild, 9 cases of moderate and 1 case of severe allergic reaction. There was no significant difference of the incidence of delayed allergic reaction among patients of different age and sex(all P>0.05). The main manifestations in 25 mild patients were skin rash and pruritus; 9 cases of moderate allergic reaction mainly manifested as eyelid and facial edema; 1 severe patient showed general chills and sudden drop of blood pressure. Two patients took loratadine; 33 patients were treated with glucocorticoids, mainly dexamethasone and methylprednisolone. One patient with severe allergic reaction was given intravenous infusion, oxygen inhalation and low dose dopamine to maintain blood pressure. All patients recovered after therapy. Conclusions    The incidence of contrast media-induced delayed allergic reaction shows no significant difference among patients of different age and sex. Clinicians should strengthen the awareness of delayed allergic reaction and pay close attention to patients who have used contrast media to make early detection and intervention for contrast media-induced allergic reaction.