2020 年第 2 期 第 15 卷

碘造影剂过敏史患者冠状动脉介入术前应用甲泼尼龙和苯海拉明预防过敏的对比研究

Methylprednisolore and diphenhydramine in preventing allergic reactions in patients with iodine contrast agent allergy history undergoing coronary intervention

作者：钱海燕1黄觊2马文健1史文册1俞梦越1

英文作者：

单位：1中国医学科学院阜外医院冠心病诊治中心，北京100037；2首都医科大学附属北京安贞医院心内科100029

英文单位：

关键词：碘造影剂；过敏；甲泼尼龙；苯海拉明

英文关键词：

• 摘要：

• 【摘要】目的    观察甲泼尼龙和苯海拉明用于碘造影剂过敏史患者预防再次碘造影剂过敏的效果。方法    回顾性分析2013年8月至2017年9月中国医学科学院阜外医院明确为碘造影剂过敏需再次行经皮冠状动脉介入（PCI）术的患者168例，其中58例术前接受甲泼尼龙和苯海拉明防过敏处理（甲泼尼龙组），110例术前仅接受苯海拉明防过敏处理（苯海拉明组）。2组在术前1 h内分别给予甲泼尼龙80 mg静脉滴注+苯海拉明20 mg肌内注射、苯海拉明20 mg肌内注射，分别记录术前术后恶心、呕吐、皮肤表现、血压、心率、血指标、心电图等。结果    2组患者入院前碘造影剂过敏反应均主要表现为皮肤损害，包括红斑、丘疹、荨麻疹，2组间过敏反应发生情况差异均无统计学意义（均P＞0.05）。2组患者首次过敏距此次PCI的时间差异无统计学意义［（223±125）d比（197±142）d，P＞0.05］。2组患者PCI术中均换用不同于第一次过敏的造影剂，甲泼尼龙组只有1例（1.7%）患者在使用造影剂25 min时发生恶心呕吐；而苯海拉明组共有10例（9.1%）患者发生过敏，患者接触碘造影剂的时间为（15±6）min，包括局部皮肤反应5例（4.5%）、全身皮肤反应4例（3.6%）和血压下降1例（0.9%），苯海拉明组过敏反应发生率高于甲泼尼龙组（P=0.001）。PCI术中2组患者大多选择碘克沙醇，占比分别为甲泼尼龙组52例（89.7%）和苯海拉明组98例（89.1%）。结论    甲泼尼龙联合苯海拉明用于含碘造影剂过敏患者再次使用碘造影剂时预防过敏反应安全且效果显著。

• 【Abstract】Objective    To observe the effects of methylprednisolone and diphenhydramine on allergic reactions in patients with history of iodine contrast agent allergy. Methods    Clinical data of 168 patients with iodine contrast agent allergy history undergoing percutaneous coronary intervention(PCI) from August 2013 to September 2017 in Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively analyzed; 58 patients were treated with intravenous administration of methylprednisolone 80 mg plus intramuscular injection of diphenhydramine 20 mg at 1 h before PCI（methylprednisolone group）; 110 patients were treated with intramuscular injection of diphenhydramine 20 mg at 1 h before PCI（diphenhydramine group）. Nausea, vomiting, skin manifestations, blood pressure, heart rate, blood indices and electrocardiogram were analyzed. Results    Skin manifestations（erythema, papule and urticaria） were the main reactions of iodine contrast agent allergy. There were no significant differences in allergic manifestations and first allergy to PCI time［（223±125）d vs （197±142）d］ between groups（all P＞0.05）. The patients were treated with alternative iodine-containing contrast agent during PCI. Only 1 patient（1.7%） in methylprednisolone group had nausea and vomiting at 25 min after contrast agent administration. Ten patients(9.1%) developed allergic reactions in diphenhydramine group, with a mean onset time of （15±6）min, including local skin reactions in 5 cases(4.5%), systemic skin reactions in 4 cases(3.6%) and blood pressure reduction in 1 case(0.9%). Incidence of allergic reactions in diphenhydramine group was significantly higher than that in methylprednisolone group(P=0.001). Iodixanol was the common used agent in PCI［52 cases（89.7%） for methylprednisolone group and 98 cases（89.1%） for diphenhydramine group］.Conclusions    Methylprednisolone plus diphenhydramine is safe and effective in preventing allergic reactions in patients with iodine contrast allergy history when re-exposing to iodine contrast media.