含碘對比劑事前試驗的預測價值

The Value of Pretesting in the Use of Lodinated Contrast Media

李潤川(Rheun-Chuan Lee) ； 鄧木火(Michael MH Teng) ； 王世叡(Soo-Ray Wang)

《中華放射線醫學雜誌》 22卷5期 (1997/10) Pp. 189-192

摘要

含碘對比劑的不良反應可分為化學毒性及特異性反應兩類。兩者均非免疫球蛋白E之居間反應，因此結膜或皮下注射事前試驗並不具預測的效果，靜脈注射小劑量對比劑做事前試驗，雖然仍有人從事，但未證實為有效篩選潛在不良反應的方法。過去卅無來各種方式的事前試驗已被一再地證實並不敏感有效，並且事前試驗本身即可能造成危險，甚至造成死亡。現今大多數國家注射含碘對比劑前已不實施事前試驗。我們也不認為事前試驗有實施的必要性。如果病患過去有含碘對比劑反應史，則可改採超音彼或磁振造影檢查。

關鍵字

對比劑 ； 事前試驗 ； 藥物不良反應

並列摘要

Reactions to iodinated contrast media are generally classified as either idiosyncratic or chemotoxic. Since these reactions are not IgE mediated, procedures such as skin and conjunctival pretesting are not helpful. Intravenous injection of a test dose has not geen validated as an effecive screen for adverse reactions, although this approach does have its advocates. In the past thirty years, all forms of pretesting have been shown repeatedly to be insensitive and inherently dangerous. Several deaths and many serious reactions caused by pretesting have been reported. In the presence of overwhelming evidence that pretesting is not only useless in the prediction of reactions, but also potentially hazardous, the pretesting practice has decreased or been abandoned in most countries at the present time. For patients who have had a previous adverse reaction to iodinated contrast media, alternative procedures may be used, such as sonography, contrast enhanced magnetic resonance imaging, or radiography with nonionic contrast medium.
In conlusion, there is no indication for pretesting in the use of iodinated contrast medium.

並列關鍵字

Contrast mediun ； Pretest ； Adverse drug reaction