160例经皮冠状动脉介入治疗患者造影剂肾病的预防分析

The prevention of radiographic contrast nephropathy in PCI

目的观察不同年龄、不同血肌酐（Scr）水平和不同造影剂用量患者在经皮冠状动脉介入治疗（PCI）前、后肾功能的变化，探讨造影剂肾病（CIN）的防治对策。方法选择我院2003年1月～2007年12月间的PCI患者160例，其中≥65岁64例（老年组）；〈65岁96例（非老年组）；各组根据Set水平分成132．6μmol／L≤Scr〈265．2μmol／L和Scr〈123．6μmol／L亚组；根据造影剂用量分成50ml≤用量〈150ml和用量〈50ml亚组。比较PCI前、后各组、各亚组Scr、肌酐清除率（Ccr）和尿素氮（BUN）水平的变化。结果老年组中除Ser〉132．6μmol／L和用量〉50ml亚组PCI后BUN、Scr水平增高（P〈0．05）、Cer值降低（P〈0．05）外，其他各组、各亚组间PCI前后各指标的变化均无显著性差异（P〉0．05）。结论PCI时病例选择非常重要，年龄〈65岁、Scr〈132．6μmol／L时较安全，在Ser〈265．2μmol／L时、150m1以内造影剂对肾功能不会造成严重影响；老年组中Set〉132．6μmol／L、用量〉50ml亚组易出现肾功能损害。对于任何年龄，PCI时应选择Ser〈265．2μmol／L的患者；对老年PCI患者，造影剂用量尽量控制在150ml以内。

Objective To observe renal functional variance before and after the percutaneous coronary artery intervention（PCI） in patients with different age ,serum creatinine and volume of contrast medium,and discuss preventive measures pertaining to radio-contrast medium induced nephropathy （CIN）. nethodsEighty cases undergone PCI procedures were recruited from January 2003 to December 2006.32 patients were classified as elderly group and 48 patients as non-elderly group, and then they were classified as 132.6 pμmol/Ll≤Scr 〈265.2 μmol/L subset group,Scr 〈 132.6μmol/L subset group,50ml≤the volume of contrast medium 〈 150 ml subset group and the volume of contrast medium 〈 50 ml subset group. Compare the level of serum creatinine,creatinine clearance and urea nitrogen among groups. Results The level of serum creatinine,creatinine clearance and urea nitrogen of each group and subset group had not significant differences except the older age-group whoes Scr 〉 132.6μmol/L and the volume of contrast medium 〉 50 ml. Conclusions Constrast medium is safer for patients whose age 〈 65 years old and Scr 〈 132.6μmoL/L. There is not severe effect on the renal function if the Scr 〈265.2 μmol/L and the volume of contrast medium 〈 150 ml. We should select patient with Scr 〈 265.2 〈mol/L for PCI regardless age, and the volume of contrast medium should be less than 150 ml for the older PCI patients.