Iothalamate Meglumine Induced Transient Tachycardia during Intravenous Bolus Injection for CT and Parameters Related to Its Discomfort

快速靜脈注射Iothalamate Meglumine引起的短暫性心跳加速及病人不舒服度的探討

楊石崇(Shih-Chung Yang) ； 劉省宏(Shing-Hong Liu) ； 張剛鳴(Kang-Ming Chang)

《中華放射線醫學雜誌》 33卷3期 (2008/09) Pp. 131-136

摘要

電腦斷層對於檢查病患而言，是一種非常強而有力的工具。它對於顯示人體解剖結構、發現疾病、顯示疾病分期等，既方便又有效率。在電腦斷層檢查過程中，常會經由靜脈注射含碘顯影劑，以增強組織的對比度，突顯出病兆的特徵。在多排偵檢器電腦斷層(MDCT)時代，常常更須配合使用高壓注射器(power-injector)迅速且大量地經靜脈注射含碘顯影劑，以充分發揮多排偵檢器電腦斷層快速掃描的優點。離子性含碘顯影劑的副作用遠多於非離子性含碘顯影劑，但除少數適應症外健保局目前只給付離子性含碘顯影劑的費用。本研究的目的在建立電腦斷層快速靜脈注射離子性含碘顯影劑的生理即時監測系統，以及早發現病人的不舒服。
在電腦斷層快速靜脈注射離子性含碘顯影劑Iothalamate Meglumata時，我們利用血氧濃度偵測器暨雙波長脈波感測器即時監測病人心跳變異。我們共收集了67個案例（平均年齡48±13歲）。結果顯示靜脈注射離子性含碘顯影劑後，每分鐘心跳數會急速上升而後緩下降。心跳回復時間較慢者或心跳加速較多者會感覺較不舒服，不舒服與舒服兩群間的數據差異具有統計學上的意義。小於50歲的族群心跳加快明顯高於大於50歲的族群。
在電腦斷層快速靜脈注射離子性含碘顯影劑時，利用血氧濃度偵測器暨雙波長脈波感測器即時監測病人病理生理變化是一個可靠的方法，可讓我們及早發現病人的不舒服。

並列摘要

Computed tomography (CT) is a powerful imaging tool for generating clinically useful information. Iodinated contrast medium (ICM) is usually used to enhance the imaging intensities and the tissue contrast, anyway it can cause a variety of adverse reactions. Ionic ICMs are associated with more serious reactions than non-ionic ICMs, but the Bureau of National Health Insurance only pays for the use of ionic ICM with CT in Taiwan, except for certain specific indications. The goal of our study is to develop a real-time method for monitoring patients who received rapid intravenous injection of ionic ICM during CT examination.
Sixty-seven patients were enrolled in this study (aged 48±13 years, mean ± SD), comprising 38 males (aged 47±11 years) and 29 females (aged 48±14 years), who received CT examinations with intravenous bolus injection of iothalamate meglumine. A standard pulse oximeter was used to detect the heart rate (HR) changes that were considered to represent the response to the ionic ICM.
The results showed that the HR per minute rose rapidly to peak and then re turned to baseline slowly. Patients felt much discomfort when there was rapid increase in HR or when the HR-recovery time is longer. Moreover, the HR-increase after intravenous injection of ionic ICM is greater in younger patients under 50 years than in older patients.
We conclude that an oximeter can be used to reliably monitor the pathophysiologic condition of patients and the discomfort related to tachycardia during a rapid intravenous injection of ICM for CT.