Ukukhusela impendulo kwidayi ye-IV
Inyevenous (IV) idayi (idayi enikezwe nge-vein) -iyaziwa ngokuba yi-radiocontrast media (RCM)-isetyenziswa kakhulu eUnited States ngezifundo ezahlukeneyo ze-radiological, ezifana ne-angiograms, i-ray-ray, i-imagery magnetic resonance (MRI), kunye i-computed tomography (CT). Iimpendulo ezingalunganga kwiRCM ziqhelekileyo, nangona i-allergies ihamba ngokubanzi.
Iintlobo zeRidiocontrast Media
Ngokuqhelekileyo, kukho ezimbini iintlobo ezisisiseko zeRCM ezisetyenzisiweyo ezisetyenziselwa ezininzi izifundo ze-radiological.
Ziquka:
- Ionic high-osmolality media media (HOCM)
- Imidiya engezantsi ye-osonlality ye-osmolality (LOCM)
I-LOCM ibe yindlela ekhethiweyo yedayi ye-IV kwiminyaka yamuva, enikwe irekhodi engcono yokhuseleko. Nangona kunjalo, kubiza ngakumbi kune-HOCM.
Iimpendulo ezinokuthi zenzeke nge-IV Dye
Le yindlela eyenzeka ngayo xa ulawulwa yiRCM:
- Ukuphendula okubi: Ezi ziqhelekileyo, zivela kwipesenti ezi-3 ukuya kwi-15 ekhulwini zabantu ababafumanayo. Uninzi lwaloo mpendulo lubumnene kwaye luquka umvakalelo wokufudumala, ukuncwina, kunye nokuhlanza. Ngokuqhelekileyo, ezi zimpawu zenzeka kuphela ngexesha elifutshane kwaye azidingi unyango.
- Ukuphendula ngokulinganayo: Ezi ziquka ukuhlanza okukhulu, imihlathi kunye nokuvuvukala, kwaye kuvele kwi-0.02 yepesenti ukuya kwi-2 ekhulwini labantu abafumana iRCM. Bahlala befuna unyango.
- Ukukhathazeka, ukusabela ngokusongela ubomi: Oku kubandakanya i- anaphylaxis , kwaye oku kuyenzeka ngo-0.04 kweepesenti ukuya kwi -02 pesenti yabantu abafumana i-RCM, ngesantya sokufa komntu ongu-170 000.
Ubungakanani bokuphendula kwi-LOCM buncinci kakhulu kunokuba ne-HOCM, nangona ukuphendula okunzima kakhulu, kubandakanywa nokufa, kuye kwabikwa ukuba kwenzeka kwiirhafu ezifanayo kunye zombini iintlobo zeendaba ezifaniyo.
I-Dryergia kwi-IV Dye ayiyiyo imfutho
Unokumangaliswa xa ufumanisa ukuba iimpendulo eziya ku-RCM aziyiyo imvelo yendalo, nto leyo ithetha ukuba akukho nonyango okhoyo okhoyo owenza ukuphendula.
Kunoko, iRCM yenza i- histamine nakwezinye iikhemikhali kwiiseli zeentsimbi .
Izingozi zokuphendula kwi-Dye ye-IV
Ezi zinto zibonakala zibeka abantu emngciphekweni ophezulu wokuphendula kwi-RCM:
- Ukuphendula kwangaphambili kwiRCM
- Isifuba
- Imbali yezilwanyana
- Imbali yesifo senhliziyo
- Imbali yesifo seengtso
- Ukuthatha i- beta-blockers
- Abafazi
- Abantu abadala (kubonakala bekho emngciphekweni omkhulu wokuphendula)
Inkolelo ye-Seafood
Nangona inkolelo eyaziwayo, ukuba ne-seafood kunye ne-shellfish yokungabikho komzimba akuyikubeka engozini yokwanda kwe-RCM. I-Shellfish yokungabikho komzimba ngenxa ye-protein yezinto zokutya, kungekhona i-iodine content. Ukongezelela, ukuba unesifo sengqondo sokuhlamba iodeod iodine okanye iodididi, awukho mngcipheko ophezulu wokuphendula kwiRCM.
Ukuchonga i-Allerger to IV Dye
Ngelishwa, akukho vavanyo olufumanekayo lokuxilonga i-RCM. Ukuvavanywa kwesikhumba kunye nokuhlolwa kwe- radioallergosorbent (RAST) akubonwanga ukuba luncedo ekuxilongweni. Amancinci, amanani okuvavanya awanakunceda, kunye neengxelo ezinzima, ukusabela kokusongela ubomi okwenzeka emva kwemali encinci ye-RCM enikwe, kwakunye neempendulo ezinzima kunye neenthamo ezinkulu ze-RCM ezenzeka emva kokuba umntu akhuthazele umthamo omncinci wedayi ye-IV.
Ngako oko, ukuxilongwa kwe-RCM yokungabikho komzimba kwenziwa kuphela emva kokuba iimpawu zenzeke.
Ngaphandle koko, kunokwenzeka ukuba kuqinisekiswe ukuba umntu unobungozi obuninzi bokusabela kwi-RCM esekelwe kwimingcipheko yengozi njengoko kuchaziwe ngasentla.
Unyango lwe-Allergy kwi-IV Dye
Ukunyangwa kwe-actic response to RCM kufana ne-anaphylaxis kunoma yintoni na isizathu. Unyango lunokubandakanya i-epinephrin injectable kunye ne- antihistamines , kunye nokusetyenziswa kwamanzi asemzimbeni wokuxinzelelo lwegazi oluphantsi kunye nokutshitshiswa.
Ukukhusela impendulo kwiDye ye-IV
Ukuba uye waphendulwa kwiRCM, ukukhusela iimpendulo zeRCM ezizayo kufuneka zibandakanye oku kulandelayo:
- Ukuthetha nodokotela wakho ngeengozi kunye neenzuzo zokuqhuba uvavanyo kunye neRCM nokuba ingaba ezinye iindlela ziyafumaneka
- Ukusebenzisa i-LOCM kunokuba i-HOCM
- Ukusebenzisa amayeza phambi kokulawulwa kweRCM ukukhusela okanye ukunciphisa ithuba lokuphendula, kuquka:
- I-Prednisone, i-50mg yomntu omdala, ngomlomo uthathwa ngeeyure eziyi-13, iiyure ezingama-7 kunye neyure eli-1 ngaphambi kokufumana iRCM
- I-Diphenhydramine (i-Benadryl), i-50mg yomntu omdala, ithathwe ngomlomo ngelixa eli-1 ngaphambi kokufumana iRCM
Imithombo:
> IBaerlocher MO, uAsch M, Myers A. Ukusetyenziswa kweeNkcazo zeMedia. I-CMAJ: I-Canadian Medical Association Journal . 2010; 182 (7): 697. i-doi: 10.1503 / cmaj.090118.
> Baig M, Farag A, Sajid J, Potluri R, Irwin RB, Khalid HMI. I-Shellfish Aller and Relation to Iodinated Contrast Media: I-United Kingdom Survey. I-Journal Journal yeCardiology . 2014; 6 (3): 107-111. i-doi: 10.4330 / wjc.v6.i3.107.
> Hong SJ, Cochran ST. Ukuphendula ngokukhawuleza kwe-Hypersensitive Response kwi-Radiocontrast Media: Ukuthintela ukusabela okuqhelekileyo. Isemgangathweno. Ukuhlaziywa kweSeptemba 1, 2017.
> Lieberman P, uNicklas RA, uRololph C, et al. Anaphylaxis-iParameter Update Update 2015. Ama-Annal of Allergy, i-Asthma & Immunology. Novemba 2015; 115 (5): 341-84.
> Pasternak JJ, Williamson EE. I-Clinical Pharmacology, Ukusetyenziswa, kunye Neempembelelo ezimbi zeAffinated Contrast Agents: A Primer for Non-radiologist. IMayo Clinic Proceedings . 2012; 87 (4): 390-402. i-doi: 10.1016 / j.mayocp.2012.01.012.