静脉水化疗法预防合并心功能不全老年患者对比剂肾病的临床研究

CLINICAL STUDIES OF INTRAVENOUS HYDRATION THERAPY TO PREVENT CONTRAST-INDUCED MEPHROPATHY IN ELDERLY PATIENTS COMBINED WITH CARDIAC DYSFUNCTION

目的探讨静脉水化疗法对合并心功能不全老年患者预防对比剂肾病的效果,同时观察是否加重心力衰竭的发生率。方法选择符合标准的患者236例,分为对照组(116例)和静脉水化组(120例),对照组冠状动脉介入术后常规液体输入,滴速1.0～1.5mL·h^(-1)·kg^(-1),3h内给予200～300mL液体量,饮水300～400mL。静脉水化组冠状动脉介入术后给予0.9%氯化钠注射液500mL+10%氯化钾10mL静脉滴入,滴速2.5～3.2mL·h^(-1)·kg^(-1),3h内给予500～600mL液体量,饮水200～300mL。结果静脉水化组患者对比剂肾病的发生率明显低于对照组(P<0.05),心力衰竭加重的发生率差异无统计学意义(P>0.05)。结论静脉水化疗法显著降低了心功能不全老年冠状动脉介入患者对比剂肾病的发生率,不增加心力衰竭加重的发生率。

Objective To investigate the effect of intravenous hydration therapy on contrast- induced nephropathy （CIN） in elderly patients who were combined with cardiac dysfunction, and observe whether increase the incidence of heart failure. Methods A total of 236 patients who were consistent with the diagnosis standard were selected and randomly divided into control group （ll6 cases）and intravenous hydration group （120 cases）, conventional infusion was given in the control group after percutaneous coronary intervention （PCI） , the drip rate was adjusted to 1 - 1.5 mL · h ^-1 · kg ^- 1,200 - 300mL volume of fluid given within 3 hours, drinking 300 -400mL. Intravenous hydration therapy group were given 0. 9% sodium chloride injection 500mL ＋ 10% potassium chloride 10mL with intravenous infusion, the drip rate 2.5 - 3.2mL · h ^-1 · kg ^- 11,500 - 600mL volume of fluid given within 3 hours, drinking 200 - 300mL. The liquid input speed was adjusted depending on the cardiac function and disease of the patients within 24 hours. Results The incidence of CIN in intravenous hydration therapy group was significantly lower than the control group （P 〈 0.05 ）. There was no significant difference of the incidence of heart failure aggravation （ P 〉 0. 05 ）. Conclusion The intravenous hydration therapy significantly reduces the incidence of CIN in elderly patients with cardiac dysfunction who underwent cornary intervention, and does riot increase the incidence of heart failure aggravation.