不同水化方案预防冠状动脉介入术后造影剂肾病的临床研究

Preventive effect of four kinds of hydration therapy on contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention

目的 探讨不同水化方案对冠状动脉介入诊疗术后造影剂肾病（CIN）的预防作用.方法 选择2010年10月至2011年10月在北京安贞医院行冠状动脉造影或介入治疗的627例患者作为研究对象,完全随机分为生理盐水组（161例）、碳酸氢钠组（159例）、生理盐水加N-乙酰半胱氨酸（NAC）口服组（157例）和碳酸氢钠加NAC口服组（150例）.所有患者均使用低渗非离子型造影剂.观察各组CIN的发生情况.结果 CIN总发生率为4.47％ （28/627）,生理盐水组、碳酸氢钠组、生理盐水＋NAC口服组、碳酸氢钠＋NAC口服组的CIN发生率分别为2.48％（4/161）、4.40％ （7/159）、5.10％ （8/157）、6.00％ （9/150）,差异无统计学意义（P =0.483）；在糖尿病合并肾功能不全患者中,应用不同干预方式的4组CIN发生率间差异无统计学意义（分别为2/6、3/5、2/7、2/10,P =0.493）.结论 生理盐水、碳酸氢钠及NAC对于降低CIN发生率无明显差异,但在糖尿病合并肾功能不全的高危患者中,碳酸氢钠联合NAC可能优于单独应用等渗晶体液水化,有降低CIN发生的趋势.

Objective To observe the preventive effect of application of sodium chloride, sodium bicarbon- ate, sodium chloride plus N-acetylcysteine （NAC） and sodium bicarbonate plus NAC on contrast agent-induced nephrotoxicity （CIN） in patients undergoing coronary angiography and/or percutaneous coronary intervention （PCI）. Methods All 627 cases of coronary angiography and/or PCI from October 2010 to October 2011 were ran- domly divided into four groups： sodium chloride group （ n = 161 ）, sodium bicarbonate group （ n = 159）, sodium chloride plus NAC group （ n = 157）, sodium bicarbonate plus NAC group （ n = 150）. All these patients used the low-osmolar nonionic contrast medium. The incidence of CIN were observed and analyzed. Results Of the 627 patients, 28 experienced CIN, and the overall incidence was 4. 47% （28/627）. CIN occurred in 4 patients （2.48%） in the sodium chloride group, 7 patients （4. 40% ） in the sodium bicarbonate group, 8 patients （5.10%） in the sodium chloride plus NAC group and 9 patients （6. 00% ） in the sodium bicarbonate plus NAC group（P =0. 483）. Among diabetes complicated with renal insufficiency patients, CIN incidence was not statistically significant in four interventions groups （2/6, 3/5, 2/7, 2/10 respectively,P = 0. 493 ）. Conclusions Sodium chloride, sodium bicar-bonate and NAC for reducing the incidence of CIN have no significant difference. In diabetes mellitus complicated with renal dysfunction, the efficacy of sodium bicarbonate plus NAC in preventing CIN is high but there is no significant difference among four groups.