前列地尔对不稳定型心绞痛患者应用造影剂后肾血流动力学的影响

Effects of alprostadil on renal hemodynamics in patients with unstable angina after using contrast media

目的探讨前列地尔对不稳定型心绞痛患者应用造影剂后肾血流动力学的影响。方法56例不稳定型心绞痛患者分为两组,行冠状动脉造影术(必要时行冠状动脉介入治疗),对照组(n=28)给予常规治疗,实验组(n=28)在常规治疗的基础上术前30 min加用前列地尔注射液10μg静脉注射,术后连续静脉注射3 d。观察(1)两组患者治疗后的肾动脉血流动力学的变化;(2)两组患者治疗后血清肌酐浓度变化。结果(1)实验组的肾血流动力学指标如收缩期最大血流速度[(82.72±4.02)cm/s vs.(74.52±3.75)cm/s,P<0.05]、舒张末期最低血流速度[(33.65±3.18)cm/s vs.(28.03±2.23)cm/s,P<0.05]、肾血流量[(588±112)mL/min vs.(521±105)mL/min,P<0.05]均较对照组显著增加,阻力指数明显降低(0.60±0.05 vs.0.68±0.07,P<0.05),差异均有统计学意义;(2)实验组术后48 h起血清肌酐浓度明显低于对照组,差异有统计学意义(P<0.05)。结论前列地尔可增加不稳定型心绞痛患者应用造影剂后肾动脉的灌注,改善肾脏的缺血状态,有益于保护肾功能。

Objectives To explore the effects of alprostadil on renal hemodynamics after the application of contrast media in patients with unstable angina. Methods Fifty six patients with unstable angina underwent coronary angiography （if necessary, coronary intervention therapy） were randomly divided into two groups. Control group （n =28） received conventional therapy, while experimental group （n=28） received 10 μg alprostadil intravenously 30 minutes before the routine treatment and lasted for 3 days after treatment. Both group were continuously observed for three days after the treatment. （1） Changes of the post-treatment renal hemodynamics and （2） serum concentrations of creatinine （SCr） in both group were carefully observed. Results （ l ） Indicators of renal hemodynamics such as systolic blood flow velocity [（82.72 ± 4.02） cm/s vs. （74.52 ± 3.75） cm/s, P〈0.05], minimum diastdic flow velocity [（33.65 ± 3.18） cm/s vs. （28.03 ± 2.23） era/s, P〈0.05], renal blood flow[（588±112） mL/min vs. （521 ± 105） mL/min, P〈0.05] in experimental group were significantly higher than those in control group, while vascular resistance index （0.60 ± 0.05 vs. 0.68 ± 0.07, P〈0.05） in experimental group was significantly lower than that in control group. （2）Serum concentrations of SCr 48 hours after the starting of the procedure in experimental group were significantly lower than those in control group（P〈0.05 ）. Conclusions Alprostadil may protects renal function in patients with unstable angina after using contrast media by increasing renal artery perfusion, and therefore improve renal ischemia.