エマージント冠動脈動脈検査中のコントラスト染料に対する重度のアレルギー反応

Jack Armstrong Bookbinder¹, Keshav Patel², Jeffrey Fitch²

¹School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA jack_bookbinder@urmc.rochester.edu.

BMJ case reports

|September 3, 2025

まとめ

以前ヨウ素対照媒体 (ICM) に反応した患者は,早期のプレメディケーションから利益を得ることができます. 移植前にステロイドを迅速に投与すると,急性心臓手術の際に重度のアナフィラクト性反応を防ぐ可能性があります.

科学分野:

心臓病科
アレルギーと免疫学

背景:

ヨウ素濃縮コントラストメディア (ICM) は心血管画像に不可欠ですが,有害な反応を引き起こす可能性があります.
ICM反応の既往歴のある患者は,再発を防ぐために慎重に管理する必要があります.

研究の目的:

ICMに対する重症のアナフィラクトイド反応の症例を,前治療にもかかわらず,病歴のある患者に報告する.
緊急処置を受ける高リスク患者の早期前治療の潜在的利点を強調する.

主な方法:

中年女性,ICMの副作用が ST上昇性心筋梗塞を呈した.
血栓解消薬の治療が失敗したため,緊急の心臓キャセテリゼーションが実施された.
アナフィラクトイド反応は,現在の病院の予備治療にも関わらず, катетеризация中に発生しました.

主要な成果:

患者はエピネフリンに耐性のある重度のアナフィラクトイド反応を経験し,管内置と圧縮器のサポートが必要でした.
この反応は,静脈内グルコチコイドとディフェンヒドラミン投与にもかかわらず,病院で発生した.

結論:

移転前に早期にプレメディケーション,特にグルココルチコイドを投与すると,重度のICM反応が緩和される可能性があります.
アナフィラキシーに対する警戒は,ICM反応が先行した患者において極めて重要であり,リスクを最小限に抑えるには,適時な予備治療が不可欠である.

キーワード:

アナフィラキシー心血管医学過敏症介入心臓科

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