低渗非离子型造影剂对肾功能影响的前瞻性研究

A prospective study on the effects of low-osmolar and nonionic contrast media on renal functions

目的 了解较大剂量新型低渗非离子型造影剂进行血管造影时对肾功能的影响。方法 前瞻性随机观察了 10 0例应用低渗非离子型造影剂碘普罗胺进行心血管和肾血管造影病人的肾功能变化 ,其中造影前肾功能正常者 96例 ,异常者 4例。于造影前及后第 1、3、5d分别监测血肌酐(Scr) ,内生肌酐清除率 (Ccr) ,血、尿渗透压 ,2 4h尿钠、尿糖和尿酶。结果 肾功能正常的 96例 ,用碘普罗胺造影后第 1d尿γ 谷胺酰转肽酶 (γ GT)与造影前比差异有显著性 (P <0 0 5 ) ,但于造影后第 3d均恢复到造影前水平。Scr与Ccr造影前、后比较差异无显著性。尿常规指标有加重者 2 2例 ,均于造影后第 3～ 5d恢复到造影前水平。造影前肾功能异常的 4例 ,用碘普罗胺造影后第 1、3dScr升高 ,Ccr下降 ;第 5d恢复到造影前水平。结论 对肾功能正常者用碘普罗胺行血管造影后可出现一过性尿酶增加 ,并出现尿糖、尿蛋白 ,第 3～ 5d后恢复正常。肾功能轻度异常者用碘普罗胺造影后Ccr下降 ,经积极处理第

Objective To investigate the effects of contrast medium, especially large dose of Iopromide, on renal functions.Methods 100 hospitalized patients who were going to have cardiac or renal angiography were selected. 96 patients had normal renal functions and 4 had slightly abnormal renal functions. Scr, Ccr, urine γ GT and urine glucose were monitored on the first, third and fifth day after angiography.Results All the 100 patients were administered with Iopromide. Of the 96 patients with normal renal functions, all had elevated urine γ GT on the first day after giving Iopromide; the level returned to normal on the third day. There was no significant change of Scr and Ccr after angiography. Of the 4 patients with abnormal renal functions, all had significant change of Scr and Ccr after using Iopromide and the levels of both returned to pre angiography level on the fifth day. Conclusions In patients with normal renal functions, Iopromide may cause transient elevation of urine γ GT level and positive urine glucose. In patients with slightly abnormal renal functions, Iopromide may cause significant decrease of Ccr and increase of Scr. However,with proper treatment, these indexes may return to pre angiography level on the fifth day after angiography.