摘要
目的比较不同溶液水化治疗防治老年对比剂肾病(CIN)的疗效。方法将45例老年缺血性心脏病患者随机分为2组,于冠脉介入诊疗术后,观察组给予0.9%氯化钠注射液、对照组给予等量0.9%氯化钠注射液和5%葡萄糖注射液混合液,以1.5 mL/(kg.h)持续泵入6 h以上,于术前、术后次日、第3天、第7天化验血清肌酐(SCr)并比较。患者均使用第二代碘造影剂。结果观察组糖尿病患者多于对照组,水化液用量显著低于对照组;观察组3例,对照组4例符合CIN诊断,SCr增幅(33.1±4.5)%;CIN患者年龄明显高于非CIN者,基线LVEF明显低于非CIN者;2组CIN发病率比较无显著性差异;6例慢性肾功能不全患者术后各时点SCr、eGFR与术前比较无显著性差异;7例慢性心力衰竭患者无心功能恶化及急性左心衰发作。结论老年冠心病患者是CIN高危人群,高龄、原有心功能减低者更易发生。水化治疗可有效保护患者肾功能,0.9%氯化钠溶液更为有利。老年慢性心力衰竭患者可以耐受术后水化治疗。
Objective It is to compare the influence of two hydration regimens on the renal function of elderly patients un- dergoing coronary angiography. Methods 45 elderly coronary artery disease (CAD) patients scheduled for coronary angioplasty were randomly assigned to receive isotonic (0.9% saline, control group) or half-isotonic (0.9% sodium chloride plus 5% glucose,observation group) hydration. Hydration liquid was administered at 1.5 mL/( kg ~ h) for six hours after the proce- dure. The data of serum creatinine (SCr) were collected before and 1 day, 3 days, 7 days after intervention. Results The in- cidence of diabetes in observe group was higher than that in control group. The contrast media dosage and SCr levels after in- tervention were not significantly different between both groups. Hydration fluid volume used in observe group was lower than control group. 3 patients in observation group and 4 ones in control group were diagnosed CIN, the.Jr average SCr growth was ( 33.1 + 4.5 ) %. CIN group was older and had lower baseline LVEF than non-CIN group. SCr levels of 6 chronic renal failure patients were not significantly different before and after intervention. No deterioration of heart function or acute left heart failure was observed in 7 chronic heart failure patients. Conclusion Elderly CAD patients with advanced age and deceased heart func- tion are more vulnerable to CIN. Hydration can effectively protect renal function and is well tolerated in elderly CHF patients. 0.9% saline isotonic hydration is superior to half-isotonic hydration.
出处
《现代中西医结合杂志》
CAS
2012年第23期2517-2519,共3页
Modern Journal of Integrated Traditional Chinese and Western Medicine