低渗造影剂在急诊PCI术中应用的安全性分析

Safety of Hypotonic Contrast Agent in Urgent Percutaneous Coronary Interventions

目的评价在急诊冠脉介入治疗的急性心肌梗死患者中,针对造影剂肾病(CIN)发生的低中危人群选择性使用价格相对便宜的低渗造影剂的安全性。方法前瞻性研究了在哈尔滨医科大学附属第一医院CCU病房接受急诊PCI的AMI患者226例,根据Mehran R危险分层将患者分为低中危组、高危组,低中危的患者随机使用等渗造影剂碘克沙醇(A亚组)或低渗造影剂碘海醇(B亚组),高危组使用碘克沙醇,采集患者基础、造影剂接触后24 h、48 h、72 h血清肌酐及尿素氮水平,并随访3年,分析两种造影剂对的患者肾功能的影响。结果患者平均年龄(59±11)岁,低中危组占63%,A亚组71人中3人发生CIN(4.2%)、B亚组73人中2人发生CIN(2.7%),A、B两亚组CIN的发生率差异无统计学意义(P>0.05)。低中危组CIN发生率为3.5%(5/144);高危组发生率为9.8%(8/82),总的CIN发生率5.8%低于文献报道。结论根据危险程度有选择地使用造影剂可降低急诊PCI造影剂肾病的发生率。针对低中危人群有选择性地使用价格相对便宜的低渗造影剂仍是安全的。

Objective To discuss the safety of using hypotonic contrast agents in population with acute myocardial infarction（AMI） at low or moderate risk for contrast-induced nephropathy（CIN） who underwent urgent percutaneous coronary intervention（PCI）.Methods In the CCU room of our hospital,226 patients with AMI received the urgent PCI.According to Mehran contrast-induced nephropathy risk stratification tool,all patients were divided into low or moderate risk group（risk score≤10） and high risk group（risk score10）.The isosmotic nonionic contrast agent Iodixanol（subgroup A） and hypotonic contrast agent Iohexol（subgroup B） were randomly used in the low or moderate risk group.Patients with high risk of CIN received Iodixanol.The serum creatinine and blood urea nitrogen levels（baselin e and 24 h,48 h,72 h） were tested.The follow-up was 3 years,and the effects of contrast agents on the renal functions were evaluated.Results There were 3 patients（4.2%） suffered with CIN in subgroup A and 2 patients（2.7%） in subgroup B respectively.No statistical difference was found between the two groups.CIN incidence was 3.5%（5/144） in low or moderate risk group and 9.8%（8/82） in high-risk group,which total CIN incidence was 5.8% lower than it in the literature.Conclusion The appropriate contrast media selected by the risk stratification can effectively reduce the incidence of the CIN in the patients who underwent urgent PCI.The selective using of hypotonic contrast agents（Iohexol） in the low or moderate risk group was safe.