不同水化疗程预防急诊PCI患者对比剂肾病的临床研究

Clinical study of different hydration treatment emergent PCI patients to prevent contrast induced nephropathy

目的观察不同水化疗程在急诊冠脉介入术患者中的应用在预防对比剂肾病方面效果。方法选择240例急性ST段抬高型心肌梗死患者,均行急诊冠脉介入术(PCI),分为A、B、C三组。三组患者均于PCI术前用0.9%生理盐水进行静脉水化,同时A、B、C三组术后水化维持时间分别为6、12、24 h。比较三组治疗前、治疗24、48、72 h后血清肌酐、胱抑素C水平情况及CIN发生率。结果治疗24 h后,三组中C组血肌酐、胱抑素C均最低,与A、B两组对比显著差异(P<0.05);治疗48 h后,三组中C组血肌酐最低与A、B两组的两两比较均有显著差异(P<0.05);治疗72 h后,C组血肌酐水平显著低于A、B两组(P<0.05),C组胱抑素C明显低于A组(P<0.05),与B组比较差异无统计学意义(P<0.05)。结论急诊PCI患者术后予以24 h水化可有效预防CIN发生,改善预后,患者精神与经济负担得以减轻,社会效果和经济效益显著。

【Objective】To observe the application effect of patients with different hydration treatment in emergency percutaneous coronary intervention in prevention of contrast induced nephropathy. 【Methods】240 cases of acute ST segment elevation myocardial infarction patients in our hospital from March 2010- March 2014 as the research object, underwent emergency percutaneous coronary intervention（PCI）, were divided into A, B, C three groups. Three groups of patients before PCI in 0.9% normal saline for intravenous hydration, at the same time postoperative water maintenance time in group A, B, C three groups of were respectively 6, 12, 24 h. Comparison of three groups before treatment, 24, 48, 72 h in serum creatinine, Cystatin C level and the incidence rate of CIN. 【Results】After 24 h treatment, serum creatinine, Cystatin C in group C were the lowest, difference compared to group A, B was significant（P0.05）. After 48 h treatment, significantly; serum creatinine in group C was lowest, compared with group A, B differences were signficant（P0.05）, but difference of cystatin C compared with group A, B had no significant difference（P0.05）; after 72 h treatment, the serum creatinine level in C group was significantly lower than that of A, B groups（P0.05）, cystatin C of group C was lower than that in group A（P0.05）, had no significant difference compared with B group（P0.05）. 【Conclusion】Patients with PCI were given 24 h hydration can effectively prevent the occurrence of CIN, improve the prognosis, the spirit and the economic burden of the patients can be reduced, the social effect and economic benefit is remarkable.