合并轻度肾功能不全冠心病患者行冠状动脉介入治疗效果分析

Study on percutaneous coronary intervention in patients with mild renal insufficiency

目的探讨合并轻度肾功能不全(MRI)的冠心病患者经皮冠状动脉介入治疗(PCI)的疗效和安全性。方法选择238例住院行PCI的患者,根据肾小球滤过率(GFR)分为MRI组102例和肾功能正常组(对照组)136例,MRI组行静脉水化治疗。记录两组基本临床特征、介入手术情况和肾功能变化等资料并作统计学分析。结果两组合并病史情况、心力衰竭比例、手术成功率、手术时间、X线曝光时间、使用对比剂类型、靶血管分布、靶病变类型、植入支架数目、住院期间和6个月主要不良心脏事件发生率相似(P>0.05)。MRI组年龄较大(P<0.05),体重较轻(P<0.05),对比剂用量较少(P<0.05),使用大剂量对比剂比例较小(P<0.05),对比剂肾病(CIN)发生率较高(P<0.01),差异有统计学意义。MRI组有1例CIN患者需行血液透析,但最终所有患者肾功能均能恢复至术前水平。两组不同时间血肌酐(Scr)和GFR比较均有明显差异(P<0.01),但组内比较差异无统计学意义(P>0.05)。结论通过围手术期水化治疗、减少对比剂用量等适当处理,在合并MRI的冠心病患者中行PCI效果良好,安全性高。

Objective To investigate the efficacy and safety of percutaneous coronary intervention （PCI）in patients with mild renal insufficiency （MRI）. Methods The retrospective study was performed in 238 patients underwent PCI in the hospital from Jan 2007 to June 2008. According to the glomerular filtration rate（GFR） the cases were divided into two groups： the MRI group （n=102） and the normal renal function group （control group,n=136）.Patients in the MRI group received hydration （intravenously and orally）.The data of basic clinical characteristics,intervention and renal function in both of the two groups were recorded and analyzed statistically. Results The success rate and time of operation,the time of X-ray exposure, kind of contrast media,distribution of target vessel ,type of target lesions,quantity of stents,major adverse cardiac events during hospitalization and 6 months follow-up were all similar（P〉0.05） between the two groups.Patients in the MRI group were elder and lighter（P〈0.05）.The average dose and large-dose rate of contrast media were lower （P〈0.05） while more patients suffered contrast-induced nephropathy （P〈0.01） in the MRI group.Only 1 patient received hemodialysis and all cases recovered their renal function level of preoperation.The serum creatinine and GFR were significantly different between the two groups （P〈 0.01）.But they were similar in each group （P〉0.05）. Conclusion if proper methods of treatment such as hydration and reduction of contrast media are used during peri-operative period ,PCI in the patients with MRI is safe and effective.