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20146226 Chin J Intervent Cardiol, June 2014, Vol 22, No.6 341 R541.

1 Chin J Intervent Cardiol, June 2014, Vol 22, No R541.4 WHO adverse drug reactionadr DOI /j. issn contrast media [1] X X CT [1] 1 X

2 Chin J Intervent Cardiol, June 2014, Vol 22, No.6 [2] mg/ml mosm/kg H 2 O mpa s/ ADR 1 / - 2 / [3] [2] h 2 1 h [4] ADR 1 2ADR / 1 / β [5] 4 / 3 [1] [2] 4 5

3 Chin J Intervent Cardiol, June 2014, Vol 22, No [3,6-11] [1,2,12] 2005 / [13] 1 2 PCI ml 4 / PCI, 2011ACCF/AHA/SCAI PCI 60 ml/min Class IB [8] 5 Cigarroa [14] 5ml kg/ (mg/dl 300 ml2011accf/ahaua/ NSTEMI 3.7 [7] ADR 1 contrast induced acute kidney injuryciaki [12] CIAKI 25% 0.5 mg/dlciaki CIAKI GFR 45 ml/min CIAKI 5 20 [3] CIAKI AKI [15-16] CIAKI CIAKI CIAKI [15] 2 CIAKI CIAKI CIAKI CIAKI [15,17] 1 [18] 2 CIAKI X

4 Chin J Intervent Cardiol, June 2014, Vol 22, No.6 [19] CIAKI mosmol/kg H 2 O 800 mosmol/kg H 2 O CIAKI mosmol/kg H 2 O mosmol/kg H 2 O mosmol/kg H 2 O [15,17] 3 1/ egfr CIAKI egfr MDRD [20] egfrml/(min 1.73m 2 )= 186SCr egfr CIAKI CIAKI 2 CIAKI egfr 60 ml/ (min 1.73m 2 ) [21] 6 12 h h 1.0 ml/kg h 1 h 3 ml/kg h 1.25% 1 ml/ kg h 1.25% 6 h [4] 3CIAKI 4 [7-9,21] 1 20 [2] 3 h 2 d [22] [2] 1 / / / 2 / / 3 / + [2] % [23] 0.5% 14% [22,24] [22,25] 2 90

5 Chin J Intervent Cardiol, June 2014, Vol 22, No [26] 4 IgE [27] IgE [28] [29-30] L- 3 1 [31] [32] a. 13 h 7 h 1 h 50 mg 1 h 50 mg b. 12 h 2 h 32 mg [33] c. 200 mg [34] a. PCI mg 100 mg [35] b mg 200 mg 4 h 1 h 50 mg [34] h / [36] [2] 2 [2] a / Ambu b / c β 2 / 50% / [2] a min [2] b

6 Chin J Intervent Cardiol, June 2014, Vol 22, No.6 c 2 6 [2] / a b 2550 mg 180 mg a b a 2550 mg 180 mg 2550 mg12 min / a IM IV 2550 mg12 min 0.3 mg1: ml 1: ml abimiv 610 L/min 1000 ml 1000 ml IV a IM a 1: ml510 min 10 ml 0.3 mg1: ml1 mg aim IV

7 Chin J Intervent Cardiol, June 2014, Vol 22, No L/min β μg/ IM a 0.3 mg1: ml1 mg IV a 1: ml 510 min 10 ml IV a 1: ml510 min 10 ml IM a 0.3 mg1: ml1 mg aim IV IV a 610 L/min 1: ml510 min 1 mg IM a 0.3 mg1: ml1 mg aim IV 90 mmhg L/min 1000 ml 1000 ml 60 /min IV mg 3 mg 100 / IV a 1: ml510 min 1 mg IM a 0.3 mg1: ml1 mg aim IV

8 Chin J Intervent Cardiol, June 2014, Vol 22, No ACR Manual on Contrast Media version 9. ACR Committee on Drugs and Contrast Media Solomon RJ, Natarajan MK, Doucet S, et al. Cardiac angiography in renally impaired patients (CARE) study: a randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease. Circulation, 2007, 115: ESUR Guidelinesversion 8. ESUR Contrast Media Safety Committee Lang DM, Alpern MB, Visintainer PF, et al. Elevated risk of anaphylactic reaction from radiographic contrast media is associated with both beta-blocker exposure and cardiovascular disorders. Arch Intern Med, 1993, 153: Chen Y, Hu S, Liu Y, et al. Renal tolerability of iopromide and iodixanol in 562 renally impaired patients undergoing cardiac catheterisation: the DIRECT study. EurIntervention, 2012, 22: Wright RS, Anderson JL, Adams CD, et al ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/ Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 123: Levine GN, Bates ER, Blankenship JC, et al ACCF/AHA/ SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 2011, 124:e574-e Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J, 2011, 32: Barrett BJ, Carlisle EJ. Meta-analysis of the relative nephrotoxicity of high-and low-osmolality iodinated contrast media. Radiology, 1993, 188: KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International, 2012, 2:s Yamaguchi K, Katayama H, Takashima T, et al. Prediction of severe adverse reactions to ionic and nonionic contrast media in Japan: evaluation of pretesting. A report from the Japanese Committee on the Safety of Contrast Media. Radiology, 1991, 178: Marenzi G, Assanelli E, Campodonico J, et al. Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality. Ann Intern Med, 2009, 150: Cigarroa RG, Lange RA, Williams RH, et al. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med, 1989, 86: SeeligerE, Sendeski M, Rihal CS, et al. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J, 2012, 33: Nash KHafeez AHou S. Hospital-acquired renal insufficiency. Am J Kidney Dis, 2002, 39: SeeligerE, Lenhard DC, Persson PB. Contrast Media Viscosity versus Osmolality in Kidney Injury:Lessons from Animal Studies. Biomed Res Int, 2014: Sendeski M, Patzak A, Persson PB. Constriction of the vasa recta, the vessels supplying the area at risk for acute kidney injury, by four different iodinated contrast media, evaluating ionic, nonionic, monomeric and dimeric agents. Invest Radiol, 2010, 45: Speck U. X-ray contrast media: physico-chemical properties. In: Dawson P, Cosgrove DO, Grainger RG (eds), Textbook of Contrast Media. Oxford:Informa Health Care, 1999: egfr MDRD 2006, 22: Chen Y, Hu S, Liu Y, et al. Renal tolerability of iopromide and iodixanol in 562 renally impaired patients undergoing cardiac catheterisation: the DIRECT study. Eur Intervention, 2012, 22: Christiansen C, PichlerWJ, Skotland T. Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations. Eurradiol, 2000, 10: CT : Loh S, Bagheri S, Katzberg RW, et al. Delayed adverse reaction to contrast-enhanced CT: a prospective single center study comparison to control group without enhancement. Radiology, 2010, 255: Webb JA, Stacul F, Thomsen HS, Morcos SK. Late adverse reactions to intravascular iodinated contrast media. Eur Radiol, 2003, 13: Meth MJ, Maibach HI. Current understanding of contrast media reactions and implications for clinical management. Drug Saf, 2006, 29: LaskeyWK, JenkinsC, SelzerF, et al. Volume-to-creatinine clearance ratio: apharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. J Am Coll Cardiol, 2007, 50: Trcka J, Schmidt C, Seitz CS, et al.anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? AJR Am J Roentgenol, 2008, 190: Laroche D, Aimone-Gastin I, Dubois F, et al. Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology, 1998, 209: Morcos SK. Review article: Acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol, 2005, 78: Lasser EC, Berry CC, Mishkin MM, et al. Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. AJR Am J Roentgenol, 1994, 162: Lang DM, Alpern MB, Visintainer PF, et al. Increased risk for anaphylactoid reaction from contrast media in patients on beta-adrenergic blockers or with asthma. Ann Intern Med, 1991, 115: Fischer HW, Doust VL. An evaluation of pretesting in the problem of serious and fatal reactions to excretory urography. Radiology, 1972, 103: Greenberger PA, Halwig JM, Patterson R, et al. Emergency administration of radiocontrast media in high-risk patients. J Allergy Clin Immunol, 1986, 77: Klein LW, Sheldon MW, Brinker J, et al. The use of radiographic contrast media during PCI: a focused review: a position statement of the Society of Cardiovascular Angiography and Interventions. CatheterCardiovasc Interv, 2009, 74: :

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