水化方式的差异对对比剂肾病影响的研究

Study on Effect of Different Hydration to Contrast-induced Nephropathy

目的探讨不同方式的水化对对比剂肾病（CIN）发病率的影响，从而进一步证实水化在对比剂肾病预防中的地位。方法选择2009年12月至2010年8月在东南大学临床医学院附属徐州医院心内科住院行冠状动脉介入治疗患者90例，随机分为口服水化组、一般水化组和延长水化组；口服水化组术前6h到术后6h给予饮水1500mL、一般水化组术前6h到术后6h以1mL／（kg·h）速度给予O．9％；延长水化组术前6h到术后24h以1mL／（kg·h）速度给予0．9％生理盐水维持静滴；三组患者测定术前和术后48-72h之间血肌酐值。结果三组患者的对比剂肾病发病率不同，其中延长水化组发病率最低；一般水化组和延长水化组患者对比剂肾病发病率均较口服水化组低，且有统计学差异（P〈0．05），但延长水化组患者对比剂肾病发病率与一般水化组相此无统计学差异（P〉0．05）。结论冠脉造影或PCI术前和术后静脉滴注生理盐水的水化治疗较口服水化降低了患者对比剂肾病的发病率。

Objective To investigate the impact of different hydration on the morbidity of CIN. It is confirmed that there is impact of hydration on the preventive status of CIN. Methods Ninety patients who accept percutaneous coronary intervention are selected from cardiology department of Xuzhou Hospital attached to southeast university clinical medical school from Dec 2009 to Aug 2010. The ninety patients are randomly divided into three groups, the oral hydration group, the general hydration group and the extended hydration group. The oral hydration group is treated with drinking water 1500mL between 6 hours before the surgery and 6 hours after the surgery. The general hydration group is treated with 0.9% normal saline to keep dripping at the speed of 1 mL/（kg.h） between 6 hours before the surgery and 6 hours after the surgery. The extended hydration group is treated with 0.9% normal saline to keep dripping at the speed of 1 mL/（kg＊h） between 6 hours before the surgery and 24 hours after the surgery. All three groups receive the test of serum creatinine （Scr） and at the beginning and were tested again Scr level 48-72 hours after the surgery. Results The percentage of CIN is different between three groups： the extended hydration group has the lowest percentage; the general hydration group and the extended hydration group have the lower percentage than oral hydration group and there is significant statistic difference （P〈0.05）. The general hydration group and the extended hydration group has no significant statistic difference（P〉0.05）. Conclusion Hydration using 0.9% normal saline before and after cardiac angiography or PCI can help lower the percentage of CIN against hydration using drinking.