前列地尔脂微球载体注射液预防老年人造影剂肾病的临床观察

Clinical evaluation of Lipo-PGE_1 on prophylaxis of radiocontrast-induced nephropathy in elder patients

目的:观察老年肾功能不全患者造影后给予前列地尔脂微球载体注射液(Lipo-PGE_1,商品名凯时)对造影剂肾病的预防作用。方法:58例肾功能不全的老年患者(＞60岁)分为两组,在接受造影剂检查后对照组(n=30)予常规治疗,试验组(n=28)在常规治疗基础上加用Lipo-PGE,20μg,iv,连续3 d。观察尿量变化、肾功能变化、造影临床相关事件(肺水肿、心肌梗死、体克)的发生率及死亡率。结果:试验组和对照组的造影剂肾病发生率分别为21．4%(6/28)和46．7%(14/30),两组比较差异有显著性(P＜0．01);需暂时肾替代治疗发生率分别为7．1%(2/28)和16．7%(5/30);造影临床相关事件的发生率分别为3．6%(1/28)和20．0%(6/30),两组比较差异有显著性(P＜0．01);住院死亡率分别为3．6%(1/28)和6．7%(2/30),组间比较差异无显著性(P＞0．05)。结论:肾功能不全的老年患者在给予造影剂检查后立即给予Lipo-PGE_1治疗可以有效地防止造影剂对肾功能的损害,减少并发症的发生而改善患者的预后。

Objective： To discuss the prophylaxis of Lipo-PGE1 for radiocontrast-induced nephropathy in patients with impaired renal function that were intravenously injected with contrast media. Methods： Fifty-eight inpatients with impaired renal function at age of 60 years old or above were randomly received either conventional therapy （n = 30） or Lipo-PGE1 （n = 28, 20μg,iv） for 3 days immediately after they were injected with contrast media. The therapeutic outcomes were assessed based on the status of renal function, incidence rate of adverse events related to the contrast media, e. g. , pulmonary edema, myocardial infarction and stroke, and rate of mortality and temporary renal-replacement therapy. Results ： The patients in the conventional and Lipo-PGE1 therapy experienced the incidence of radiocontrastinduced nephropathy of 46.7% versus 21.4 % （ P 〈 0.01 ） , the temporary renal-replacement therapy （ hemodialysis and hemofihration） of 16.7% versus 7.1% （ P 〈0. 05）, the incidence rate of adverse events of 20.0% versus 3.6% （P〈0.01）; and the mortality of 6.7% versus 3.6% （P〉0.05）. Conclusion The Lipo-PGE1 offers prophylaxis and better prognosis on the radiocontrast-induced nephropathy in patients with impaired renal function.