心导管术后造影剂神经毒性：病例报道和112例病例综合分析

发布时间：2018-01-26 10:58

本文关键词： 造影剂神经毒性心导管术碘造影剂一过性皮质盲高血压　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：我们报道了一名72岁的男性患者,接受经皮冠状动脉介入治疗(PCI)处理右冠状动脉慢性闭塞病变(CTO),术中注入非离子型低渗性造影剂碘帕醇。术后患者出现头痛、意识下降、激惹和夜间谵妄。头颅CT和MRI未显示脑出血或梗塞。通过对症支持治疗后患者迅速恢复,未遗留任何其他并发症。目的:造影剂神经毒性(contrast-induced neurotoxicity,CIN)是一种发生在心导管术治疗期间,由碘造影剂引起的急性可逆性神经系统障碍。本研究旨在找出影响造影剂神经毒性(CIN)症状持续时间的独立危险因素,并描述心导管术后CIN的流行病学特征、发病机理、临床表现、具体治疗方案和预后情况。方法与结果:一、通过Pubmed,Medline和Web of science数据库进行检索,并对所有相关病例文献进行回顾。从所有病例报道中提取相关数据,通过Kaplan-Meier和COX回归分析进行数据处理,绘制生存曲线和风险曲线。通过回顾所有病例文献,讨论心导管术后CIN的流行病学特征、发病机理、临床表现、具体治疗方案和预后情况。二、共检索到73篇共112例心导管术后CIN病例报道。其中男性占59.82%;50.89%的病例伴有高血压;超过50%的病例使用非离子型和低渗性造影剂。临床表现方面,一过性皮质盲(TCB)占58.93%,是所有病例中最常见的症状。症状可发生在心导管术中到术后72小时内;症状缓解可发生在起病15分钟到6周后,平均为 37.78±44.15小时。男性(HR:1.666,95%(CI0.990～2.804,p = 0.055)、高渗性造影剂(HR:1.806,95%CI 0.406～8.035,p = 0.019)可能在CIN恢复中起保护作用;高血压(HR:0.221,95%CI0.085～0.575,p=0.002)可能是阻碍CIN恢复的危险因素。结论:CIN是心导管术的一种罕见但重要的并发症,需与脑梗塞鉴别。男性、高渗性造影剂可能是保护因素而高血压是CIN恢复的危险因素。因CIN只需对症支持治疗即可有效恢复且预后较好,故在临床实践中不应忽视,以避免因错误诊断而误停抗血小板药物或进行不必要的溶栓治疗。
[Abstract]:We report a 72-year-old male who underwent percutaneous coronary intervention (PCI) for the treatment of chronic right coronary artery occlusive lesions (CTO). Intraoperative injection of non-ionic hypotonic contrast agent iopaxol resulted in headache and decreased consciousness. Irritation and nocturnal delirium. Cranial CT and MRI showed no cerebral hemorrhage or infarction. Patients recovered quickly after treatment with symptomatic support. No other complications remained. Objective: contrast st-induced neurotoxicity with contrast agent neurotoxicity. CINs are one that occurs during cardiac catheterization. Acute reversible nervous system disorders caused by iodine contrast agents. This study was designed to identify independent risk factors that affect the duration of neurotoxicity of contrast agents (CINs). And describes the epidemiological characteristics, pathogenesis, clinical manifestations, specific treatment and prognosis of CIN after cardiac catheterization. Methods and results: first, through Pubmed. The Medline and Web of science databases were searched, and all relevant case literatures were reviewed. Relevant data were extracted from all case reports. The survival curve and risk curve were drawn by Kaplan-Meier and COX regression analysis. The epidemiological characteristics of CIN after cardiac catheterization were discussed by reviewing all the case literatures. The pathogenesis, clinical manifestation, specific treatment plan and prognosis. Second, 73 reports of 112 cases of CIN after cardiac catheterization were reported, of which 59.82 cases were male. 50.89% cases were accompanied by hypertension. Nonionic and hypotonic contrast agents were used in more than 50% patients. In clinical manifestations, transient cortical blindness accounted for 58.93%. It is the most common symptom in all cases. The symptoms can occur within 72 hours after cardiac catheterization. Symptom relief occurred 15 minutes to 6 weeks after the onset of the disease, with an average of 37.78 卤44.15 hours. P = 0.055 (P = 0.055), HRW 1.806 / 95 CI 0.4068.035p = 0.019) may play a protective role in the recovery of CIN. High blood pressure HR1: 0.221 / 95 CI 0.085 / 0.575. Conclusion 1: cin is a rare but important complication of cardiac catheterization and needs to be distinguished from cerebral infarction. Hypertonic contrast agent may be the protective factor and hypertension is the risk factor for the recovery of CIN. Because CIN can recover effectively and has a good prognosis, it should not be ignored in clinical practice. In order to avoid false diagnosis and the wrong stop of antiplatelet drugs or unnecessary thrombolytic therapy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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