等渗和低渗造影剂在冠状动脉介入诊疗中对肾功能影响的对比观察

Renal Toxicity Comparison by Using Isosmolar and Low-Osmolar Contrast Media in Patients With Percutaneous Coronary Intervention

目的：对比观察等渗和低渗造影剂在冠状动脉介入诊疗中对肾功能影响。方法：根据患者心功能（NYHA分级）、糖尿病、年龄3项因素按“不平衡指数最小的原则”对2006-05至2009-05行冠状动脉介入诊疗的366例患者进行随机分组，将患者分为等渗造影剂组（n=161）与低渗造影剂组（n=205）。人选患者术前给予充分的生理盐水水化治疗，所有患者介入治疗前1天及治疗后第1～5天、术后14天分别检查肾功能指标，并同时观测尿量。了解肾功能变化及造影剂相关性肾损害（CIN）的发生情况。结果：在充分水化治疗的基础上，等渗造影剂组与低渗造影剂组患者在术后24—72h与术前相比均有不同程度的肌酐水平的升高，且这影响在术前肾功能不全患者中更为持久（达4～5天），但差异均没有达到统计学意义（P〉0．05）。同时，等渗造影剂组与低渗造影剂组之间在相应的时间段对肾功能影响和CIN发生率差异也均无统计学意义（P〉0．05）。结论：在充分水化治疗的基础上，等渗造影剂和低渗造影剂对。肾功能影响和造影剂肾病的发生无明显区别。水化治疗仍是降低CIN发生的经济、有效、副作用少的措施。

Objective： To compare the renal toxicity by using isosmolar and low-osmolar contrast media in patients with percutaneous coronary intervention （PCI）. Methods： Based on the principle of ＂minimize the unbalanced coefficient＂, 366 patients with PCI from 2006 to 2009 in our hospital were summarize. They were divided into two groups, Low-osmolar group （ n = 205） and Isosmolar group （ n=161 ） by the cardiac function （NYHA criteria）, diabetes history and age. All patients were routinely treated with hyperhydration before PCI, the renal function was examined 1 day before PCI, 1 - 5 days after PCI and 14 days after PCI, the quantity of urine and creatinine clearance rate were checked at the same time to detect the＂ contrast media induced nephropathy （CIN）. Results ： With sufficient hyperhydration treatment, the serum creatinase increased at varying degrees in both groups at 24 - 72h after PCI, this influence lasted longer （4 ~ 5 days） in patients with chronic renal failure （CRF）, while those changes had no statistic difference pre- and post-PCI procedure （P 〉 0.05 ）. Meanwhile, the renal function changes and the ratio of CIN occu- rrence had no real difference between two groups （ P 〉 0. 05 ）. Conclusion： By sufficient hyperhydration treatment, the renal function damage and the occurrence of CIN presented no sta- tistic differences by using either low-osmolar or isosmolar contrast media. Hyperhydration is an effective method for preventing the renal toxicity and CIN with the advantages of less side effect and lower cost in patients with PCL.