응급실과 병동에서 발생한 CT 조영제의 혈관 외 유출의 임상양상 = Clinical Manifestations of Contrast Media Extravasation in the Emergency Department and the Ward

국문 초록 (Abstract)

목적 응급실과 병동에서 발생한 CT 조영제의 혈관 외 유출의 임상양상과 기여하는 인자에 대해 비교 분석하고자 하였다.
대상과 방법 2013년 1월부터 2015년 12월까지 응급실과 병동에서 조영 증강 전산화단층촬영시행 후 조영제 혈관 외 유출이 발생한 환자를 대상으로 나이, 성별, 조영제 주입 부위, 조영제투여 속도, 전산화단층촬영 종류 및 촬영 시간대, 혈관 외 유출 중증도를 비교 분석하였다.
결과 응급실과 병동의 조영제 혈관 외 유출의 발생률은 각각 0.34%, 0.37%였다. 병동과 응급실모두 60세 이상이 많았고, 여자에서 발생빈도가 높았다. CT 종류는 복부 CT가 많았으며, 조영제 주입 속도는 2~3 mL/s가 가장 많았다. 또한 병동에서는 주간(14명, 56.0%), 응급실에서는 야간(10명, 62.5%)에 발생 빈도가 높았다. 응급실(9명, 56.3%)이 병동(8명, 82.8%)에 비해 중증 비율이 높았다. 전체 환자를 대상으로 경증군(24명)과 중증군(17명)의 임상양상을 비교 분석하였을 때는 조영제 주입부위 중 팔 오금에서 통계학적으로 유의한 차이를 보였으며(p = 0.013), 전산화단층촬영에서는 복부(p = 0.012)와 혈관조영술(p = 0.014)에서 유의한 차이를 보였다.
결론 응급실과 병동에서 발생한 조영제 혈관 외 유출의 임상양상은 큰 차이가 없어 환자의 입원장소보다는 사전예방이 더 중요하다. 또한 응급실에서는 야간에 발생률이 높고 중증도가높기 때문에 상대적으로 주의를 요한다.

다국어 초록 (Multilingual Abstract)

Purpose Contrast media extravasation (CME) is an adverse reaction after administration of contrast media during CT examinations. The purpose of this study was to evaluate the frequency, management, and outcomes of extravasations and to assess the risk factors for CME in the emergency department (ED) and the ward.
Materials and Methods This retrospective study was conducted at a single academic urban hospital from January 2013 to December 2015. We analyzed the medical records of all patients who experienced CME after undergoing a CT scan. We compared the patients’ age, sex, underlying disease, injection site, injection flow rate, time of CT examination, type of CT examination, and severity of injury between those in the ED and the ward.
Results CME occurred in 41 (0.36%) of 114767 patients, which included 16 (0.34%) in the ED and 25 (0.37%) in the ward. Both groups were more frequent in those aged older than 60 years and in female. Additionally, the abdominopelvic CT type and 2–3 mL/s as the injection rate were more common in both groups. However, CME was more frequent during the nighttime (10, 62.5%) in the ER, while it was more common in the daytime (14, 56.0%) in the ward. Severe complications were more frequent in the ER (9, 56.3%) compared with the ward (8, 32.8%).
There were no significant differences in CME between the ED and the ward. When comparing the clinical manifestations in the mild and severe groups, the antecubital fossa (33.3% and 0%, respectively; p = 0.013) for the injection site and abdominopelvic CT (41.7% and 82.4%, respectively; p = 0.012) and CT angiography (41.7% and 5.87%, respectively; p = 0.014) for the CT examination showed significant differences between the mild and severe groups.
Conclusion In this study, there were no significant clinical differences in CME between the ED and ward. Thus, prevention is more important than the place of admission. Radiologists and emergency physicians should pay attention to CME in the ED because it frequently occurs at night and results in more severe complications.

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