冠心病患者经皮冠状动脉介入术后并发造影剂肾病的危险因素分析及防治策略探讨

Risk factors of contrast-induced nephropathy after percutaneous coronary intervention in patients with coronary heart disease and the countermeasures

目的总结分析接受冠脉介入治疗的冠心病患者发生造影剂肾病(contrast induced nephropathy,CIN)的危险因素、临床预后及防治策略。方法回顾总结1232例冠状动脉介入治疗中91例并发CIN患者的危险因素、心血管事件及防治策略。结果术前伴随的慢性肾功能不全、糖尿病和大剂量使用造影剂与CIN的发生密切相关。CIN患者住院期间心源性死亡率,以及术后1年的心源性死亡率、心肌梗死发生率、心血管事件发生率均较非CIN组患者的明显升高。结论慢性肾功能不全、糖尿病和造影剂剂量是3个独立的CIN危险因素,而且CIN可以影响病人的预后。目前加强冠脉介入治疗围手术期的综合管理,特别是水化疗法,是目前防治CIN的重要策略。

Objective To identify the risk factors of contrast-induced nephropathy（CIN） after coronary interventional therapy（PCI） in patients with coronary heart disease and analyze the clinical outcomes and the preventive measures of CIN.Methods Ninety-one patients who developed CIN after PCI were retrospectively analyzed to identify the risk factors and explore the preventive measures.Results CIN was strongly associated with pre-procedural chronic renal failure,diabetes mellitus and administration of large-dose contrast.The incidence of cardiac mortality in hospital or in the follow-up at one year after PCI,and the incidence of myocardial infarction or major adverse cardiac events in the follow-up at one year were obviously higher in patients with CIN than those without CIN.Conclusion Chronic renal failure,diabetes mellitus and large-dose contrast administration are 3 independent risk factors of CIN,which affects the prognosis of the patients.Reinforcement of a comprehensive perioperative management of PCI,especially a rigorous preoperative preparation,can be an important strategy for prevention of CIN.