老年人造影剂肾病及临床相关因素分析被引量：23

Contrast nephropathy in elderly and its related clinical factors

下载PDF

导出

摘要目的探讨老年人造影剂肾病(contrastnephropathy,CN)的临床相关因素及其转归。方法回顾性分析老年住院患者使用造影剂前后血清肌酐的变化。结果①105例老年人接受造影剂检查,均使用低渗或等渗非离子型造影剂,剂量99.8±37.7ml(39～200ml),43.81%(46/105例)接受水化(静脉或口服水化)。②6.67%老年人发生CN,肾功能正常者的发生率1.35%,而在慢性肾功能不全者的发生率高达19.35%(两者比较P<0.05)。③慢性肾功能不全、慢性充血性心力衰竭是老年人发生CN的危险因素,而与增龄、是否有创的造影检查、造影方法、造影剂的剂型、合并糖尿病或高血压等无关。④7例发生CN的患者,5例血清肌酐恢复正常,1例遗留慢性肾功能衰竭,1例合并多脏器功能衰竭死亡。结论选用肾毒性小的造影剂、控制造影剂的剂量和水化能够使老年人安全使用造影剂。发生CN的危险因素是慢性肾功能衰竭或慢性充血性心力衰竭,给予对症治疗大多数CN患者肾功能恢复。 Objective To explore the related clinical factors of contrast nephropathy (CN) in the elderly and its outcome. Methods The changes in serum creatinine of the elderly inpatients before and after using contrast media were retrospectively analyzed. Results ①105 patients were examined by low osmolality or iso-osmolality contrast media with (99.8±37.7)ml (39~200 ml), and 43.81% of cases (46/105) received hydration (intravenously or orally). ②6.67% of ones developed CN, with 1.35% occurred in those with normal kidney function, but 19.35% in ones with chronic renal insufficiency (P<0.05). ③Chronic renal insufficiency and chronic congestive heart failure were the risk factors of CN development in the elderly, except variables as aging, invasive angiography, radiography methods, contrast media formulation diabetes or hypertension. ④ Of 7 cases with CN, 5 had recovered serum creatinine, 1 complicated with chronic renal failure, 1 died from multiple organs failure. Conclusions The elderly could safely use contrast media with low toxicity to kidney and proper dosage and hydration. Chronic renal failure or chronic congestive heart failure was the risk factors of development of CN. Most of patients with CN could recover their renal function by proper treatment.

作者李美花范利

机构地区解放军总医院老年心肾科

出处《中国老年学杂志》 CAS CSCD 北大核心 2005年第6期649-651,共3页 Chinese Journal of Gerontology

关键词造影剂肾病老年人急性肾功能衰竭 Contrast nephropathy Elderly Acute renal failure

分类号 R692.5 [医药卫生—泌尿科学]

引文网络
相关文献

参考文献9

1Waybill MM, Waybill PN. Contrast media-induced nephrotoxicity: identification of patients at risk and algorithms for prevention[J]. J Vasc Intern Radiol, 2001;12:3-9.
2Berg KI. Nephrotoxicity related to contrast media[J].Scand J Urol Nephrol,2000;34:5317-22.
3Aspelin P, Aubry P, Fransson SG, et al . Nephrotoxic effects in high risk patients underlying angiography[J].N Engl J Med, 2003;348:491-9.
4Murphy SW,Barrett BJ,Parfrey PS.Contrast nephropathy[J].J Am Soc Nephrol, 2000;11:177-82.
5Rudnick MR, Goldfarb S, Wexler L,et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients:a randomized trial. The iohexol cooperative study[J]. Kidney Int,1995;47:254-61.
6Madyoon H, Croushore L, Weaver D, et al . Use of fenoldopam to prevent radiocontrast nephropathy in high-risk patients[J]. Cathet Cardiovasc Intervent, 2001;53:341-5.
7Trivedi HS, Moore H, Nasr S, et al . A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity[J]. Nephron Clin Pract, 2003;93:C29-34.
8Jones A, Haynes W, MacGilchrist AJ, et al . N-Acetyl-cysteine(NAC) is a potent peripheral vasodilator[J]. Gut, 1994;35(Suppl 5):S10.
9Esplugas E, Cequier A, Gomez-Hospital JA, et al . Comparative tolerability of contrast media used for coronary intervention[J]. Drug Saf, 2002;25:1079-98.