Ngā werohanga pāpāho rerekē pēhanga teitei—tae atu kiPūwero kotahi CT, Ngā werohanga upoko-rua CT, Ngā werohanga MRI, mengā werohanga pehanga teitei angiography—he mea nui mō te kounga whakaahua tātaritanga. Heoi, ko te whakamahinga hē o ēnei ka tūpono ki ngā raruraru nui pērā i te whakawhitinga o te ira, te pirau o te kiko, ngā tauhohenga kino rānei. Mā te piri ki ngā mahi whakatūpato e ahu mai ana i ngā taunakitanga ka noho haumaru te tūroro me te whai huatanga o te whakaahua.
1. Aromatawai me te Whakarite Tūroro
Te Tirotiro i te Mahi a te Whatukuhu me te Whakarōpūtanga Mōrearea
Aromatawai GFR: Mō ngā rongoā kei roto i te gadolinium (MRI), tirotirohia ngā tūroro mō te whara whatukuhu whakapeka, te mate whatukuhu kino mau tonu rānei (GFR <30 mL/min/1.73 m²). Āta karohia te whakamahi mēnā kāore ngā painga tātaritanga e nui ake i ngā mōrearea NSF (nephrogenic systemic fibrosis).
Ngā Taupori Mōrearea Nui: Me whakamātautau i mua i te tukanga mō te mahi whatukuhu mō te hunga mate huka, te hunga toto toto tiketike, me ngā kaumātua (>60 tau te pakeke). Mō te rongoā whakahāngai iodine (CT/angiography), arotakehia te hītori o te nephropathy i puta mai i te rongoā whakahāngai.
Aromatawai Mate Pāwera me ngā Mate Pūngāwerewere
- Tuhia ngā tauhohenga ngawari/taumaha o mua (hei tauira, te urticaria, te bronchospasm). Whakamahia he rongoā corticosteroids/antihistamine mō ngā tauhohenga o mua.
- Kaua e whakamahi i ngā rangahau rerekētanga whiriwhiri mō te mate huango kore pumau, te ngoikore o te ngākau, te pheochromocytoma rānei.
Kōwhiringa Urunga Toto
Te Wāhi me te Rahi o te Kātene: Whakamahia ngā kātene IV 18–20G ki ngā uaua o mua o te puku, o te ringaringa rānei. Āta karohia ngā hononga, ngā uaua ringa/ringaringa, ngā peka rānei kua ngoikore te tohanga toto (hei tauira, i muri i te tango i te mastectomy, i ngā fistula dialysis). Mō ngā rere >3 mL/hēkona, me whakamahi ngā kātene ≥20G.
Te Whakatakoto i te Katitere: Whakanekehia ≥2.5 cm ki roto i te uaua. Whakamātauria te āheinga mā te horoi i te uaua ki te tote i raro i te tirotiro tika. Āraia ngā katitere e ātete ana, e mamae ana rānei i te wā e horoi ana.
2. Te Whakaritenga o ngā Taputapu me ngā Pāpāho Whakarerekētanga
Te Whakahaere i te Āhua Whakarerekētanga
Whakahaere Pāmahana: Whakamahanahia ngā matū whai iodine ki te ~37°C hei whakaiti i te matotoru me te mōrearea o te extravasation.
Kōwhiringa Kaihoko: Pai ake ngā kaihoko iso-osmolar, iti-osmolar rānei (hei tauira, iodixanol, iohexol) mō ngā tūroro mōrearea nui. Mō te MRI, ka whakaitihia e ngā kaihoko gadolinium macrocyclic (hei tauira, gadoterate meglumine) te pupuri gadolinium.
Whirihoranga Werohanga me te Whakakorenga Hau
Ngā Herenga Pēhanga: Whakatakotoria ngā paepae whakatūpato (te nuinga o te wā 300–325 psi) hei kite wawe i te urunga mai.
Tikanga Whakarerenga Hau: Hurihia ngā ngongo, horoia te hau mā te whakamahi i te tote, ā, whakaūtia kia kore he mirumiru. Mō ngā werohanga MRI, kia tika te whakarite i ngā wāhanga kore-ferromagnetic (hei tauira, Shenzhen Kenid's H15) hei ārai i ngā tūponotanga o te pere.
Ripanga: Ngā Tautuhinga Werohanga e Manakohia ana mā te Āhua
| Āhuatanga | Tere Rere | Rōrahi Whakarerekē | Kaiwhai Tote |
|————————|——————|———————|——————-|
| Te Angiography CT | 4–5 mL/s | 70–100 mL | 30–50 mL |
| MRI (Neuro) | 2–3 mL/s | 0.1 mmol/kg Gd | 20–30 mL |
| Angio ā-Taiao | 2–4 mL/s | 40–60 mL | 20 mL |
3. Ngā Tikanga Werohanga Haumaru me te Aroturukitanga
Te Werohanga me te Tūnga Whakamātautau
- Werohia te whakamātautau tote i te 0.5 mL/s teitei ake i te rere rerekētanga kua whakaritea hei whakaū i te āheinga o ngā raina me te kore whakatakotoranga o te ngongo toto.
- Whakakorea ngā waewae me ngā waewae mā te whakamahi i ngā whitiki whakapiri/rīpene; kaua e piko te ringa i te wā e tirotirohia ana te uma/puku.
Te Whakawhitiwhiti Kōrero me te Aroturukitanga Wā-tūturu
- Whakamahia ngā waea whakawhitiwhiti kōrero mō te whakawhitiwhiti kōrero ki te tūroro. Tohutohutia ngā tūroro kia ripoata tonu i te mamae, te mahana, te pupuhi rānei.
- Aroturukihia ā-kanohi ngā wāhi werohanga i ngā wā kāore i te aunoa. Mō te whakaoho aunoa a te CT, tohua he kaimahi ki te tirotiro mamao.
Ngā Whakaaro Whakauru Motuhake
Ngā Raina Waenga: Whakamahia noa ngā PICC/CVC ka taea te wero hiko (he ≥300 psi te whakatauranga). Whakamātauria te hokinga mai o te toto me te kaha ki te horoi ki te tote.
Ngā Raina Intraosseous (IO): Mō ngā āhuatanga ohorere. Whakawhāitihia ngā tere ki te ≤5 mL/s; rongoāhia ki te lidocaine i mua hei whakaiti i te mamae.
4. Te Whakarite mō ngā Āhuatanga Ohotata me te Whakaiti i ngā Tūponotanga Kino
Tikanga Whakawhānui Whakarerekētanga
Urupare Tonu: Kati te werohanga, hiki ake te waewae, tāpirihia he kōpeke matao. Mēnā he nui ake i te 50 mL te rahinga, he pupuhi nui rānei, toro atu ki te taote pokanga.
Maimoatanga ā-waha: Whakamahia he kirikiri dimethylsulfoxide (DMSO) he kākahu rānei kua rumakina ki te dexamethasone. Āta tirohia ngā takai pēhanga.
Te Anaphylaxis me te Ārai i te NSF
- Kia wātea ngā kete ohorere (epinephrine, bronchodilator). Whakangunguhia ngā kaimahi ACLS mō ngā tauhohenga kino (taunga: 0.04%).
- Tirohia te mahi a ngā whatukuhu i mua i te MRI; karohia ngā rongoā gadolinium raina i roto i ngā tūroro e whakawhirinaki ana ki te dialysis.
Ngā tuhinga me te whakaaetanga whai mōhiotanga
- Whakaaturia ngā mōrearea: ngā tauhohenga ohorere (whakapaipai, ponana), NSF, te extravasation rānei. Tuhia te whakaaetanga me ngā tau o te kaihoko/rōpū.
Whakarāpopototanga
Ko ngā werohanga rerekē pēhanga teitei e hiahia ana ki ngā tikanga haumaru pakari:
Manaaki tūroro-arotahi: Whakarōpūtia ngā mōrearea (whatukuhu/mate pāwera), whakarite kia pakari te urunga IV, ā, kia whiwhi whakaaetanga whai muri i te mōhio.
Te tika hangarau: Whakatikatika i ngā werohanga, whakamanahia ngā raina kore-hau, me te whakawhaiaro i ngā tawhā rere.
Te mataara matatau: Te aro turuki i te wā tonu, te whakarite mō ngā āhuatanga ohorere, me te piri ki ngā aratohu motuhake a te kaihoko.
Mā te whakauru i ēnei whakatūpato, ka whakaitihia e ngā tīma ira-iwi ngā mōrearea me te arotau i te hua tātaritanga—kia noho tonu te haumaru o te tūroro hei mea nui i roto i ngā whakaahua nui.
"Ko te rerekētanga i waenga i te tikanga noa me te aituā nui kei roto i ngā taipitopito o te whakarite." — I tangohia mai i te ACR Contrast Manual, 2023.
LnkMed
I te whanaketanga o te hangarau whakaahua hauora, kua puta mai he maha ngā kamupene e taea ana te tuku hua whakaahua, pērā i ngā werohanga me ngā ngira.LnkMedKo te hangarau hauora tētahi o ēnei. E whakarato ana mātou i tētahi kohinga katoa o ngā hua tātaritanga āwhina:Pūwero kotahi CT，Pūwero upoko rua CT,Werohanga MRImeDSA werohanga pēhanga teiteiHe pai te mahi tahi me ngā momo waitohu matawai CT/MRI pērā i a GE, Philips, Siemens. Haunga te werowero, ka tukuna atu hoki e mātou te werowero me te ngongo hei whakamahi mā ngā momo waitohu werowero pērā i a Medrad/Bayer, Mallinckrodt/Guerbet, Nemoto, Medtron, Ulrich.
Ko ngā kaha matua e whai ake nei: ngā wā tuku tere; Ngā tohu tiwhikete katoa, he maha ngā tau o te wheako kaweake, he tukanga tirotiro kounga tino tika, he hua tino mahi, ka mihi nui ki a koe mō tāu patai.
Te wā tuku: Hurae-19-2025
