急性心肌梗死患者行急诊冠脉介入治疗后造影剂肾病的临床研究

Contrast-induced Nephropathy Following Urgent Coronary Intervention in Patients with Myocardial Infarction:A Clinical Study

目的了解低渗非离子造影剂对行急诊冠脉介入治疗术的急性心肌梗死患者肾功能的影响,探讨造影剂肾病(CIN)对患者预后的影响。方法选择2004年10月～2007年3月在北京友谊医院及首都医科大学大兴医院接受急诊冠脉介入治疗术的急性心肌梗死患者236例,患者均应用低渗非离子造影剂。测定介入治疗前和术后第1、2、3d肾功能,分析造影剂对冠状动脉介入术患者肾功能的影响,并记录住院期间主要不良事件。结果236例患者中,男184例,女52例,平均年龄(64.6±11.5)岁,发生CIN46例,发生率为19.5%;CIN组中原有肾功能不全者6例,心功能不全者19例,同非CIN组比较差异有统计学意义(P<0.01)。平均造影剂剂量CIN组为(328±166)ml,非CIN组为(248±124)ml,两组比较差异有统计学意义(P<0.01);CIN组在住院期间主要不良事件发生率(除复发心绞痛外)及病死率明显高于非CIN组,差异有统计学意义(P<0.05)。结论急性心肌梗死患者行急诊冠脉介入治疗后CIN的发生率较高,CIN可增加患者住院期间主要不良事件及病死率,对高危患者需要进行有效的预防措施。

Objective To analyze the effect of low osmolar nonionic contrast medium on renal function in patients with acute myocardial infarction （AMI） undergoing urgent percutaneous coronary interventions. , and to study the incidence and risk factors of contrast - induced nephropathy （ CIN ）. Methods We enrolled 236 patients with AMI who underwent urgent coronary interventions from October 2004 to March 2007. All patients received low osmolar nonionic contrast medium, and we measured serum creatinine concentration （Cr） at baseline and on the 1st, 2nd and 3rd days after that, to observe the adverse clinical events and mortality during hospitalization. Results CIN occurred in 46 patients out of the 236 patients （ 184 males and 52 females with an average age of 64. 6 ± 11.5 ） with an incidence of 19.5 %. The incidence of CIN in CIN group （6 with renal insufficiency and 19 with heart failure ） was significantly higher than in non - CIN group （ P〈0. 01 ）, the average contrast dosimeter was 328 ± 166 ml in CIN group and 248 ± 124 ml in non - CIN group, and significant difference-Was： found between the two groups （ P 〈 0. 01 ）. Patients developing CIN had longer hospitalization （ 14 ± 8 d vs. 7 ± 4 d ; P 〈 0. 001 ） with more complicated clinical course and higher mortality rate （ 22% vs 0. 6% ; P 〈 0. 001 ）. Conclusion Contrast - induced nephropathy frequently complicates in urgent percutaneous coronary interventions. It developes higher in - hospital complication rate and mortality.. Thus, preventive strategies are needed, particularly in high - risk patients.