不同水化途径防治对比剂肾病的临床研究

Clinical study of different hydration ways to prevent contrast induced nephropathy

目的比较不同水化途径补充生理盐水防治对比剂肾病（contrast induced nephropathy，CIN）的效果，为临床寻找最佳水化治疗途径，提高水化治疗CIN的效果。方法150例拟行冠状动脉造影术、外周血管造影术患者，随机分为经口、外周静脉、中心静脉途径3组，各组50例，术前、术后均补充生理盐水2000ml，观察3组患者术前、术后1～5d尿量、肾功能、内生肌酐清除率，血、尿β2-微球蛋白浓度变化，同时行床边心脏超声评价充分水化治疗对心功能影响。结果所有患者术后血肌酐水平、内生肌酐清除率、血和尿胆-微球蛋白较术前均有轻度升高。随时间推移，所有患者尿量增加，血肌酐水平下降，内生肌酐清除率及血、尿β2-微球蛋白浓度降低至手术前水平。经中心静脉途径水化治疗，血肌酐、内生肌酐清除率及血、尿β2-微球蛋白3d恢复，外周静脉途径5d。肾功能恢复，经口途径肾功能恢复最晚。3组充分水化治疗不影响左室收缩末期、舒张末期容积，左室射血分数无统计学差异，不影响血流动力学。结论3种不同水化途径补充生理盐水均可有效预防和治疗CIN，且不影响心功能，但中心静脉途径患者尿量、肾功能恢复更快，方法简单，创伤小，效果最好，疗效可靠。

Objective To compare different approaches of saline water supplement for the treat- ment and prevention of contrast induced nephropathy effects, so as to find the best water treatment method for the clinical therapeutic and improve the hydration effect of contrast induced nephropathy. Methods 150 cases of patients with coronary angiography or peripheral vascular angiography were randomly divided into an oral group, a peripheral intravenous group and a central venous channels group, 50 cases each. Observe the three groups of patients urine, renal function, endogenous creati- nine clearance rate, urine β2-microglobulin concentration of perioperative 1~5 days, evaluation of the adequate hydration treatment effects on cardiac function of bedside cardiac ultrasound at the same time. Results All patients with renal function serum creatinine and endogenous creatinine clearance rate, urine β2-microglobulin were to some extent increased compared with the preoperative, and the urine volume increased, serum creatinine level decreased, endogenous creatinine clearance rate and and urine β2-microglobulin concentrations recovered to the preoperative level over time. By means of central venous hydration therapy, serum creatinine, endogenous creatinine clearance rate and urine β2-MG 3 days recovery, peripheral vein 5 days recovery of renal function, renal function recovery by the oral route at the latest. Three full hydration therapy does not affect the left ventricular end-systolic, end-diastolic volume, left ventricular ejection fraction was no statistical difference does not affect hemodynamics. Conclusions Three different ways to add hydration with normal saline may be effective pre- vention, treatment, contrast-induced nephropathy, without affecting cardiac function, but the central venous channel in patients with urine output and renal function recovery faster, method is simple, less trauma, the effect is best reliable efficacy. Three different ways of physiological saline water supple- ment can effectively prevent and treatment contrast induced nephropathy and not influence the heart function, but the urine volume and renal function recovery faster, the method is simple, less trauma, safe and reliable in the patients with center vein.