对比剂肾病的诊断和治疗课件.pptVIP

* The first human contrast angiogram is said to have taken place in 1919 and employed potassium iodide to opacify the veins of an upper extremity. Subsequently, a variety of other agents were utilized, each accompanied with considerable toxic potential. Selectan, the 1st organic iodide was introduced in 1929 and was followed by a number of modified compounds (eg Uroselectin, Diodrast). In the 1950s agents containing a fully substituted benzene ring containing 3 molecules of iodine was introduced. Since then, a variety of agents have followed that differ in several categories. Osmolality is the ratio of iodine molecules to osmotically active particles in the contrast agent. High osmolar agents have 3 iodine atoms for every 2 osmotically active agents (the cation and anion). Contrast agents in this group have 1500 mOsm/kg. Low osmolar contrast agents have osmolalities in the 600-1000 mOsm/kg range. This is achieved either by 6 iodine atoms per 2 osmotically active particles or by 3 iodine atoms per 1 osmotically active group. Efforts to further reduce osmolality lead to a class of contrast agents with 6 iodine atoms per 1 osmotically active group. After addition of sodium and calcium to the compound, this class possesses an osmolality of 290 mOsm/kg. The ionicity refers to the compound containing an ionizable group. All high osmolar contrast agents are ionic. However, the low osmolar agents can be either ionic or nonionic. The iso-osmolar contrast agents are currently nonionic. Further, the chemical structure of the commercial contrast agent contains either one or two benzene rings. Monomeric contrast agents contain one benzene ring whereas the dimeric contrast agents contain two benzene rings. Finally, the viscosity of the contrast agents differs according to its chemical structure and formulation with the iso-osmolar contrast agents having the highest viscosity. * 1. Harris KG, Smith TP, Cragg AH, Lemke JH. Nephrotoxicity from contrast material i