2种对比剂对冠脉介入患者肾功能的影响

Influences of two contrast media on renal function in PCI patients

目的观察等渗及低渗对比剂对Mehran危险评分中高危患者肾功能的影响。方法应用Mehran危险评分系统对拟行介入患者进行评估,选取中高危患者(评分≥6分)182例。随机分为碘克沙醇组89例和碘普罗胺组93例,分别应用相应对比剂,冠脉介入术前及术后48 h、7 d检测血肌酐峰值水平,比较2组对比剂肾病发生率及不良事件发生率。结果 182例患者皆进入结果分析。冠脉介入术后48 h 2组患者血清肌酐峰值水平存在显著性差异(P<0.05);7 d时2组患者肌酐水平无显著性差异。对比剂肾病发生率碘克沙醇组7.9%,碘普罗胺组18.3%,2组比较有显著性差异(P<0.05)。2组患者不良反应事件发生率比较无显著性差异(P>0.05)。结论对于中高危患者,应用等渗对比剂比低渗对比剂能减少对比剂肾病的发生率。

Objective It is to observe the influence of low-osmosis contrast medium and iso-osmosis contrast medium on kidney function of high-risk patients of Mehran risk score. Methods 182 high-risk patients estimated by Mehran risk score system （ score 〉16） were selected, and were divided randomly into iodixanol group with 89 cases and iopromide group with 93 cases. All the patients underwent homologue contrast medium before percutaneous coronary intervention. The serum creatinine levels before angiography, 48 hours and 7 day after admission were measured. The rate of contrast medium induced nephropathy （CIN） and adverse events in both groups were observed and compared. Results 182 patients were involved the result analysis. On the hours 48 after operation, serum creatinine levels of two groups were different （P〈0.05） ; on the day 7, the differences between the two groups were not significant （P 〉0.05）. The rate of CIN was 7.9% in experimental group and 18.3% in control group, there was significant difference between them （P 〈 0.05） ; there was no significant difference in rate of adverse reaction between the two groups （P 〉 0.05）. Conclusion For high risk patients the rate of CIN may be less likely to develop when iodixanol is used, rather than low-osmolar contrast media iopromide.