接受規則洗腎的腎友,偶而身體有狀況時,還是需要安排一些檢查,去幫助診斷,其中,電腦斷層(CT)、核磁共振(磁振造影、MRI)、心導管檢查、或者血管攝影等等,都常需要借助顯影劑的幫忙,來讓影像看得更清楚、更好判讀。
然而,大家聽到要打顯影劑,總是會擔心,這些顯影劑留在體內會不會造成傷害呢?要不要做完檢查之後,馬上安排血液透析,把顯影劑清除掉呢?
先講結論:
電腦斷層、心導管、血管攝影的顯影劑,按照原本規則的時程透析即可!
核磁共振的顯影劑,最好將透析安排在檢查後,不要隔太久。
2017年美國放射學會所出版的顯影劑手冊(Contrast media manual v10.3 P.42)中提到,注射了含碘之顯影劑(常用於電腦斷層、心導管檢查或血管攝影)之後,沒有必要安排馬上血液透析,由於透析患者的腎臟已經幾乎沒有功能了,所以顯影劑不至於造成腎臟功能進一步的傷害了。然而,還是要提一下,有兩個潛在風險須注意一下:
1. 小便量原本還多的患者,理論上可能有小便減少的風險,然而,這個想法到目前為止還只是猜測,並沒有相關研究能夠佐證這個風險真的存在。
2. 高滲透壓的顯影劑,理論上有造成體內液體量增加、而導致肺水腫的風險,然而,早在1994年就有研究表示,使用顯影劑之後的體內水分、體重、以及滲透壓等等數據,都沒有明顯變化。(補充說明,這個研究所使用的顯影劑之劑量為:電腦斷層 150 ml,血管攝影 40-225 ml。)
因此,如果患者接受的顯影劑劑量超過上述的量,又或者患者本身就有水量過多的傾向或危險,如心臟功能不佳、或水分自我控制非常不佳等等,那麼,或許馬上接受透析,是有點幫忙的。
不過,其實放射科醫師在安排腎友檢查的時候,也會盡量減少顯影劑的劑量,以減少這樣的風險產生,大部分情況下,一次電腦斷層的顯影劑劑量約 100 ml 左右,因此,大致上都不至於過量的。
最後,再強調一次結論:
注射了含碘之顯影劑(常用於電腦斷層、心導管檢查或血管攝影)之後,絕大部分不需要馬上安排血液透析。
請按照原本血液透析的時間,去接受血液透析就可以了。
那麼,核磁共振呢?請待下篇分曉~連結由此去。
再嘮叨一下,至於患有慢性腎臟病,但還沒開始洗腎的患者,做完檢查後,不需要為了移除顯影劑,而預防性的立刻接受血液透析,因為沒有好處。
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