Biến chứng liên quan đến thuốc cản quang
Từ suy thận đến phản vệ
TS.BS. Nguyễn Quốc Thái
VIỆN TIM MẠCH VIỆT NAM




Phân loại thuốc cản quang
1. Thuốc cản quang tia X (Radiographic
Contrast Media)
2. Thuốc đối quang từ (MR Contrast Media)
3. Thuốc cản âm (Ultrasound Contrast
Media)


Phân loại thuốc cản quang tia X
Thuốc cản quang

Negative
(Khí, O2, CO2)

Oily

Positive

Iodine compound

Barium
GIT


Xử trí các biến chứng cấp tính
Nổi mày đay
1. Ngừng tiêm thuốc
2. Không cần điều trị trong phần lớn trường hợp.
3. Cho kháng Histamin H1: uống, tiêm bắp.
Nếu triệu chứng nặng và lan rộng cho thuốc đồng vận alpha (co
động và tĩnh mạch): epinephrin 0.1-0.3 mg tiêm dưới da.


Phù mặt và thanh quản
1. Give O2 6–10 liters/min (via mask).
2. Give alpha agonist (arteriolar and venous constriction):
epinephrine SC or IM (1:1,000) 0.1–0.3 ml (= 0.1–0.3 mg) or,
especially if hypotension evident, epinephrine (1:10,000) slowly
IV –3 ml (= 0.1–0.3 mg).
Repeat as needed up to a maximum of 1 mg.
If not responsive to therapy or if there is obvious acute
laryngeal edema, seek appropriate assistance (e.g.,
cardiopulmonary arrest response team).


Tụt HA và nhịp tim nhanh
1. Legs elevated 60 degree or more (preferred).
2. Monitor: electrocardiogram, pulse oximeter, blood pressure.
3. Give O2 6–10 liters/min (via mask).
4. Rapid intravenous administration of large volumes of Ringer’s
lactate or normal saline.
If poorly responsive: epinephrine (1:10,000) slowly IV 1 ml (= 0.1
mg)
Repeat as needed up to a maximum of 1 mg.If still poorly

CO GIẬT

1. Give O2 6–10 liters/min (via mask).
2. Consider diazepam (Valium®) 5 mg IV (or more, as
appropriate) or midazolam (Versed®) 0.5 to 1 mg IV.
3. If longer effect needed, obtain consultation; consider
phenytoin (Dilantin®) infusion — 15–18 mg/kg at 50
mg/min.
4. Careful monitoring of vital signs required, particularly of
pO2because of risk to respiratory depression with
benzodiazepine administration.


Phác đồ xử trí sốc phản vệ
1.
2.
3.
4.
5.

Gọi cho đội cấp cứu
Đảm bảo đường thở
Nâng chân bệnh nhân nếu tụt áp
Thở oxy qua mask (6-10l/ph).
Adrenaline TB (1:1000): 0.5ml(0.5mg) ở người lớn, nhắc lại khi
cần thiết.
Trẻ 6-12 tuổi: TB 0.3ml (0.3mg)
Trẻ< 6 tuổi: TB 0.15ml (0.15mg)
5. Truyền TM NaCl sinh lý, Ringer lactat.
6. Kháng Histamin H1 TM.

1 h to 1 week after contrast medium injection.
• REACTIONS:
– Skin reactions similar in type to other drug induced
eruptions. Maculopapular rashes, erythema, swelling and
pruritus are most common. Most skin reactions are mild to
moderate and self-limiting.
– A variety of late symptoms (e.g., nausea, vomiting,
headache, musculoskeletal pains, fever) have been
described following contrast medium, but many are not
related to contrast medium.


Biến chứng muộn
RISK FACTORS FOR SKIN REACTIONS:
•Previous late contrast medium reaction.
•Interleukin-2 treatment.
•Use of nonionic dimers.
MANAGEMENT:
Symptomatic and similar to the management of other drug-induced skin
reactions e.g. antihistamines, topical steroids and emollients.
RECOMMENDATIONS:
•Patients who have had a previous contrast medium reaction, or who are on
interleukin-2 treatment should be advised that a late skin reaction is possible
and that they should contact a doctor if they have a problem.
•Patch and delayed reading intradermal tests may be useful to confirm a late skin
reaction to contrast medium and to study cross- reactivity patterns with other
agents.
•To reduce the risk of repeat reaction, use another contrast agent than the agent
precipitating the first reaction. Avoid agents which have shown cross-reactivity
on skin testing.

• eGFR less than 60 ml/min/1.73 m2 before intra-arterial administration
• eGFR less than 45 ml/min/1.73 m2 before intravenous administration
• In particular in combination with
• Diabetic nephropathy
• Dehydration
• Congestive heart failure (NYHA grade 3-4) and low LVEF
• Recent myocardial infarction (< 24 h)
• Intra-aortic balloon pump
• Peri-procedural hypotension
• Low haematocrit level
• Age over 70
• Concurrent administration of nephrotoxic drugs
• Known or suspected acute renal failure


Biến chứng thận do dùng thuốc can quang
Iodine
PROCEDURE-RELATED

• Intra-arterial administration of contrast
medium
• High osmolality agents
• Large doses of contrast medium
• Multiple contrast medium administrations
within a few days


Xử trí biến chứng thận do dùng thuốc can quang Iodine
Elective Examination
• Consider an alternative imaging method not using iodinebased contrast media.