下肢动脉硬化闭塞症腔内治疗不同水化方案对患者肾功能的影响

The effects of different hydration strategies before endovascular treatments to the renal function of the arteriosclerosis obliterans patients

目的 比较不同水化方案对行腔内治疗的下肢动脉硬化闭塞症（ASO）患者肾功能的保护作用.方法 2009年1-10月解放军总医院血管外科行腔内治疗的40例ASO患者,根据术前基础肌酐水平分入肾功能正常组（肌酐≤110 μmol/L）及肾功能异常组（肌酐＞110 μmol/L）.术前12 h分别给予不同水化方案,根据术后6、24、48 h肌酐（Scr）及肌酐清除率（Ccr）的变化对肾功能的变化及各水化方案进行比较分析.结果 40例患者均未达到对比剂肾病（CIN）诊断标准.术前肾功能正常的患者生理盐水水化组与非水化组术后24、48 h肌酐及肌酐清除率变化值差异有统计学意义（P＜0.05）;对术前肾功能异常的患者,NaHCO3＋生理盐水水化组与单纯生理盐水水化组术后6、24、48 h肌酐及肌酐清除率的变化值差异无统计学意义（P＞0.05）.结论 ASO患者术前生理盐水水化是预防造影剂对肾功能损害的有效方法;对于术前存在肾功能异常的患者,NaHCO3＋生理盐水联合水化预防造影剂诱导的肾功能损害的效果并不优于单纯生理盐水水化.

Objective To compare the efficacies of different hydration strategies in protecting the renal function of the arteriosclerosis obliterans（ASO） patients undergoing endovascular treatments. Methods 40 patients who underwent endovascular treatments for arteriosclerosis obliterans of lower extremities in the Vascular Surgery Department of PLA Hospital from January 2009 to October 2009 were divided into normal （eerumcreatinine≤110 μmol/L） and abnormal （serum creatine ＞ 110 μmol/L） groups according to their baseline serum concentration of creatinine before treatments. Each group was treated by different hydration strategies 12 h before procedures. Changes of serum creatinine and creatinine clearance were measured 6,24,48 h after procedures to evaluate the changes of renal function and the effects of different hydration strategies. Results No contrast-induced nephopathy （CIN） was observed among the 40 patients. There are significant differences between normal saline hydration group and control group in the changes of serum creatinine and creatinine clearance 24 h and 48 h after exposure to contrast medium for the normal renal function patients （ P ＜ 0. 05 ）. For the patients pre-existing renal dysfunction, no significant difference was found between Sodium Bicarbonate ＋ Saline group and Saline group in the changes of Scr and Ccr 6,24,48 h after exposure to contrast medium（P ＞0. 05）. Conclusion Sodium chloride provides a good efficacy for preventing the adverse effect of contrast medium to the renal function of theASO patients. For the patients pre-existing renal dysfunction, Combination hydration with sodium bicarbonate is not more effective than normal saline alone in preventing contrast-induced renal dysfunction.