冠状动脉介入治疗非透析终末期慢性肾脏病患者的临床疗效分析

The Clinical Analysis of Non-dialysis End-stage Chronic Kidney Disease Accepting Percutaneous Coronary Intervention

目的:探讨冠状动脉介入(PCI)治疗非透析终末期肾脏病患者的临床疗效及预后。方法:回顾性分析7例确诊为冠心病并进行PCI治疗的慢性肾脏病5期患者的临床资料,重点分析对比剂肾病(contrast-induced nephropathy,CIN)的发生和转归。结果:所有患者血管病变程度均较重,除第1例患者外均为多支病变,介入治疗只对一部分狭窄病变进行了干预。5例术后需要透析治疗,其中有3例出院时仍不能脱离透析。所有术后没有接受规律透析的患者均表现出血肌酐升高且超过44.2μmol/L。所有出院前脱离透析的患者,血肌酐水平恢复到介入前水平。所有患者均服用双联抗血小板药物并接受低分子肝素皮下注射,无严重出血事件发生。7例患者均在病情稳定后出院。结论:终末期非透析慢性肾疾病患者进行冠脉介入治疗,CIN发生率接近100%,水化、等渗造影剂和预防性透析的采用,对这些患者仍具有保护作用。介入前的肾功能是决定患者术后是否需要长期透析的最主要因素,对比剂比值越高,术后脱离透析的可能性越小。

Objective： To investigate the non-dialysis end-stage kidney disease patients underwent percutaneous coronary inter-vention （PCI） treatment of the clinical features and treatment outcomes. Methods： The clinical data of seven patients who diagnosed and treated with PCI for coronary heart disease in non-dialysis end-stage kidney disease were retrospectively analyzed. The analysis focused on the occurrence and outcome of contrast induced nephropathy （CIN）. Results： All patients with severe multivessel lesions except one, of which interventional treatment underwent only in part of the stenosis. All patients post PCI without regular dialysis showed more than 44.2 μmol / L increasing for creatinine. 5 patients required dialysis, of which there are three cases discharged still cannot be separated from the dialysis. Before discharge, serum creatinine of all patients separated from the dialysis declined to the level before the interven- tion. All the patients took dual antiplatelet drugs and accepted the low molecular weight heparin subcutaneous injection without serious bleeding events. Seven patients were discharged in stable condition. Conclusion： In the end-stage non-dialysis kidney disease patients with percutaneous coronary intervention, CIN rate is close to 100%. These patients still have a protective effect from hydration, isotonic contrast agent, and the adoption of prophylactic dialysis. Renal function prior to the intervention is to determine whether patients need the most important factor of long-term dialysis. The higher the contrast agent ratio, the smaller the possibility of from the dialysis post PCI.