基于循证护理的钆特醇注射液致迟发性血栓性静脉炎个案管理实践

Evidence-Based Nursing Practice in the Case Management of Delayed Thrombophlebitis Induced by Gadoteridol Injection

摘要: 钆特醇(Gadoteridol)注射液作为 磁共振成像里常用的非离子型钆对比剂，它的安全性已获广泛认可，但是仍有罕见不良反应的个案被报道出来，其中迟发性血栓性静脉炎当作一种潜在并发症，它的发生机制、临床特征以及系统化管理策略还缺少充分研究和实践指导。本研究针对一个用了钆特醇注射液后出现迟发性血栓性静脉炎的患者，意在探究怎样构建并施行一套基于循证护理观念的个案管理方法，去弥补当下临床实践里针对这类罕见不良反应缺少标准化、连续性护理流程的欠缺，通过系统查找和评判现有最佳证据，结合患者具体病况和需求，制定并执行了包含风险评估、症状监测、抗凝治疗配合、患肢护理、疼痛管理、心理支持以及长期随访的综合性管理计划。实践发现，循证的个案管理能有效推动早期识别和干预，大幅改善患者局部疼痛、肿胀这类症状，降低并发症风险，还能提高患者治疗依从度和自我管理能力。本研究为临床处理钆对比剂引发的少见迟发性静脉炎提供了能操作的循证护理路径，突出在药物不良反应管理中施行个性化、系统性护理的重要意义，对完善对比剂使用安全监控体系、提升专科护理质量以及保障患者安全有积极实践参考价值。

Abstract: Gadoteridol injection is a commonly used non-ionic Gadolinium-Based Contrast Agent (GBCA) in Magnetic Resonance Imaging (MRI), and its safety has been widely recognized. However, rare cases of adverse reactions are still reported. Among them, delayed thrombophlebitis is considered a potential complication, yet its pathogenesis, clinical characteristics, and systematic management strategies lack sufficient research and practical guidance. This study focuses on a patient who developed delayed thrombophlebitis after receiving gadoteridol injection. It aims to explore how to construct and implement a case management model based on the concept of Evidence-Based Nursing (EBN) to address the lack of standardized and continuous nursing procedures for such rare adverse reactions in current clinical practice. By systematically searching and evaluating the best available evidence, combined with the patient’s specific condition and needs, a comprehensive management plan was formulated and implemented. This plan included risk assessment, symptom monitoring, coordination of anticoagulant therapy, care of the affected limb, pain management, psychological support, and long-term follow-up. Practice has shown that evidence-based case management can effectively promote early identification and intervention, significantly improve local symptoms such as pain and swelling, reduce the risk of complications, and enhance patient treatment compliance and self-management abilities. This study provides an operable evidence-based nursing pathway for the clinical management of rare delayed phlebitis induced by gadolinium-based contrast agents. It highlights the importance of implementing personalized and systematic nursing in the management of adverse drug reactions. This has positive practical reference value for improving the safety monitoring system for contrast agent use, enhancing the quality of specialized nursing, and ensuring patient safety.