| Background:contrast-enhanced ultrasound(CEUS)has the advantages of no ionizing radiation,no renal toxicity,good repeatability and easy operation.It has been widely applied in various clinical fields especially in the diagnosis of abdominal liver disease and tumor patients after early surgery or interventional therapy efficacy evaluation and long-term repeated follow-up.At present,the most commonly used Ultrasound Contrast Agents(UCA)in our country is sulfur hexafluoride microbubbles for intravenous injection.It is a kind of pure blood pool contrast agent,which can observe tumor microvascular perfusion in real time.Although studies have shown that the incidence of adverse reactions of sulfur hexafluoride microbubbles for injection is low,serious adverse events and even death have been reported at home and abroad.At present,studies on adverse reactions of sulfur hexafluoride microbubbles for injection are mainly based on safety studies of total adverse reactions in multiple parts of the human body,and there is still a lack of studies about the incidence,severity,and related symptoms and signs of adverse reactions of sulfur hexafluoride microbubbles for injection in abdominal CEUS examination.Because CEUS plays an important role in the diagnosis and differential diagnosis of abdominal organs,especially for liver lesions,its accuracy is as good as that of Computed Tomography(CT)and Magnetic Resonance Imaging(MRI).It has become one of the conventional imaging methods recommended by domestic and foreign guidelines for the differential diagnosis of benign and malignant liver lesions.Some patients with liver tumors need long-term and repeated follow-up monitoring after early surgery or interventional therapy,especially for patients with renal failure,which is not suitable for enhanced CT and MRI examination.As the best imaging evaluation means,CEUS plays an indispensable role.Whether repeated use of UCA during follow-up will increase the incidence of adverse reactions to contrast media is worthy of further study and discussion.Therefore,it is particularly important to study the safety of sulfur hexafluoride microbubbles for injection in abdominal contrast ultrasound.At present,most of the primary hospitals in China are concerned about the serious consequences caused by improper handling of UCA-related adverse reactions,and have not yet carried out CEUS examination of abdominal organs.However,the majority of primary hospitals should play an important role in the early diagnosis of abdominal organ lesions,especially the lesions in the liver,and the evaluation after surgery or interventional treatment and long-term repeated monitoring.Therefore,studying the incidence of adverse reactions in CEUS examination of abdominal organs,summarizing the symptoms,signs and occurrence rules of adverse reactions of different degrees,and establishing standard treatment procedures of adverse reactions of different degrees are conducive to the standardized popularization and promotion of CEUS of abdominal organs and benefiting more patients.Based on this,this study summarized the incidence of adverse reactions,the degree of adverse reactions and their respective symptoms and signs of the application of sulfur hexafluoride microbubbles for injection in CEUS examination of abdominal lesions in our hospital,analyzed the risk factors,treatment and outcome of adverse reactions,and established standardized and rapid treatment procedures for different degrees of adverse reactions.Which provide detailed research basis for the safe application of sulfur hexafluoride microbubble for injection in CEUS examination of abdominal diseases.Purpose:(1)To study the incidence of adverse reactions,symptoms and signs,and risk factors of abdominal contrast ultrasound in our hospital,and to evaluate the safety of sulfur hexafluoride microbubbles for injection in CEUS examination of abdominal diseases,so as to provide evidence for rapid clinical determination of the severity of adverse reactions of UCA and rational use of sulfur hexafluoride for injection.(2)To summarize the occurrence time,treatment process and outcome of adverse reactions in abdominal contrast ultrasound in our hospital and to provide standard criteria and treatment process of adverse reactions for clinical application of sulfur hexafluoride microbubbles for injection,which is conducive to clinical promotion and popularization.Method:(1)Basic information of 91,312 patients who underwent sulfur hexafluoride microbubble abdominal CEUS examination in our hospital from January 2006 to September 2021 were collected,as well as laboratory data of past drug history,history of allergies,underlying diseases,frequency of contrast agent use,liver function,and symptoms and signs of adverse reactions in patients with adverse reactions.The incidence of adverse reactions,common symptoms and signs of abdominal contrast-enhanced ultrasound in our hospital were evaluated,and the correlation between adverse reactions and gender,age and medical history was analyzed.(2)Adverse reactions are classified according to the Contrast Agent Manual published by the American College of Radiology(ACR)in 2021.According to the types of adverse reactions,they can be divided into anaphylactic reactions and physiologic reactions.According to the severity of adverse reactions,they are classified into severe adverse reactions and non-serious adverse reactions,which are further classified into mild,moderate and severe adverse reactions.(3)Reports of 35 cases of adverse reactions related to sulfur hexafluoride microbubble contrast agents performed in our hospital from January 2006 to September 2021 were collected.The occurrence time,treatment process and clinical outcome of contrast media-related adverse reactions in abdominal contrast-enhanced ultrasound were summarized and analyzed in our hospital.Results:1.Characteristics of adverse reactions of intravenous sulfur hexafluoride microbubbles in abdominal CEUS(1)Among 91312 cases of CEUS,35 cases of adverse reactions occurred,all of which were non-serious adverse reactions.The total incidence of adverse reactions was 0.038%,including 18 cases of mild(0.020%),10 cases of moderate(0.011%)and 7 cases of severe(0.007%).The adverse reaction symptoms included allergic reaction in 7 cases(20%)and physiologic reaction in 28 cases(80%).The most common allergic reactions were local urticaria and pruritus(3 cases).The most common physiological reactions were vasovagal reaction(14 cases)and nausea and vomiting(7 cases).(2)There were no significant differences in the incidence of adverse reactions among different genders,outpatients and inpatients,and different age groups.(3)Of the 35 patients with adverse reactions to UCA,20 had a history of repeated injections of UCA.Among them,9 patients had a history of UCA injection before the occurrence of this adverse reaction,but had no adverse reactions before.This time,6 patients showed similar physiological reactions and 3 patients showed anaphylactic reactions.After the occurrence of this adverse reaction,the 6 patients were required to undergo CEUS examination due to the condition assessment,and no adverse reactions occurred again.These6 patients showed similar physiological reactions in 5 cases and mild anaphylaxis in 1 case.The other 5 patients had a history of UCA injection before and after the occurrence of this adverse reaction,and no adverse reactions occurred before or after the occurrence of this adverse reaction,and all the manifestations of this adverse reaction were physiologic reactions.(4)Of the 35 patients with adverse reactions,23 had a history of surgery or intervention.31 cases had abnormal liver function,among which aminotransferase abnormalities were the most common.2.Management of adverse reactions and patient outcomes of intravenous sulfur hexafluoride microbubbles in abdominal CEUS(1)Occurrence time of adverse reactions: 32 cases of adverse reactions occurred within 2minutes(91.4%),34 cases of adverse reactions occurred within 10 minutes(97.1%),of which6 cases were allergic reactions and 28 cases were physiological reactions.Only 1 case developed redness and rash on the arm above the injection site about 20 hours after the injection of contrast agent,which was anaphylactic reaction.(2)Treatment of adverse reactions of different degrees: Among the 18 patients with mild adverse reactions,12 were relieved after rest and 6 were relieved after receiving corresponding treatment.All patients with moderate and severe adverse reactions were relieved after receiving corresponding treatment.(3)Outcomes of patients with adverse reactions: 14 patients with adverse reactions were relieved within 30 minutes(40.0%),31 patients with adverse reactions were relieved within 2hours(88.6%),and the other 4 patients were all relieved on the same day.Conclusion:1.The clinical application of sulfur hexafluoride microbubbles for injection in abdominal organ CEUS has good safety,low incidence of adverse reactions,and most symptoms(80%)are mild or moderate.Quasi-physiological reactions accounted for the majority(80%).The occurrence of adverse reactions was independent of age,gender and hospitalization.Patients with adverse reaction of sulfur hexafluoride microvesicle used for abdominal injection mostly had abnormal liver function,surgical history or interventional history.2.The adverse reactions of sulfur hexafluoride microbubbles for injection in the clinical application of abdominal organs occur early and recover quickly,so it should be routinely subjected to rigorous medical observation for at least 30 minutes after CEUS examination.Reasonable contrast-enhanced ultrasound procedure can reduce the occurrence of adverse reactions,and is conducive to the timely treatment of adverse reactions and avoid the aggravation of symptoms. |
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