择期冠脉介入患者对比剂肾病影响因素分析

Risk factors of contrast-induced nephropathy in patients undergoing selective percutaneous coronary intervention

目的分析常规水化治疗情况下择期经皮冠状动脉介入术(PCI)患者发生对比剂肾病(CIN)的影响因素。方法连续入选我院2010年2月～2011年10月择期行PCI的冠心病患者216例,于冠脉介入围手术期给予0.9%氯化钠以1.5 mL/(kg.h)静点水化治疗,记录患者术前24 h、术后72 h内血肌酐值,分析CIN发生情况及相关影响因素。结果择期冠脉介入患者CIN发生率为8.33%(18/216),与非CIN患者比较,CIN患者年龄升高、更多合并糖尿病、肾功能下降、术中对比剂用量增多(P<0.05或P<0.01)。Logistic回归分析显示,年龄≥70岁、糖尿病、术前eGFR<60 mL/(min.1.73m2)、对比剂用量>150 mL是CIN的独立危险因素(P均<0.01)。结论常规水化治疗下冠脉介入患者仍有8.33%发生CIN,其中年龄、合并糖尿病、术前肾功能下降及对比剂用量是CIN独立危险因素,对于高危患者应高度警惕并积极预防CIN的发生。

Objective To study the risk factors of contrast-media induced nephropathy（CIN） in patients undergoing selective percutaneous coronary intervention（PCI） with routine hydration.Methods A total of 216 patients undergoing selective PCI from February 2010 to October 2011 were enrolled in this study,all patients were received infusion of saline [1.5 mL/（kg·h）] in preoperative period of PCI.Levels of serum creatinine were determined 24 hours before and 72 hours after PCI.Results Among the 216 patients,18 patients developed CIN（8.33%）.The age,diabetic mellitus,decreased renal function,and contrast medium dosage in CIN patients were significantly different from those in non-CIN patients（P〈0.05 or P〈0.01）.Identified by regression,age≥70,diabetes mellitus,preoperative eGFR60 mL/（min·1.73 m^2） and volume of contrast medium were independent risk factors of CIN.Conclusions With routine hydration,incidence of CIN was 8.33% among patients undergoing selective PCI.Age,accompanied with diabetic mellitus,decreased renal function and contrast medium dosage are the independent risk factors,which should be highly alerted in high risk patients.