冠脉介入术前后患者定量口服水化预防对比剂急性肾损伤

The effect of different hydration methods on prevention of contrast-induced acute kidney injury after cardiac intervention therapy

目的探讨定时定量饮水方法对经皮冠状动脉介入术后患者对比剂急性肾损伤的影响。方法选择接受经皮冠状动脉介入术的患者69例,分为常规水化护理组和干预1组、干预2组各23例,对照组术后常规静脉水化,干预1组术后定时定量口服水化,干预2组术前自由口服水化500mL、术后定时定量口服水化;观察各组术前、术后尿素氮(BUN)、血肌酐(Scr)、胱抑素C(CysC)及术后3h尿量等指标变化。结果不同时间各组Scr、BUN、Cys-C值比较,差异无统计学意义(均P>0.05),各组术后均无对比剂急性肾损伤或严重不良反应发生;干预2组术后3h尿量显著高于干预1组和对照组(P<0.05,P<0.01),但干预1组与对照组差异无统计学意义(P>0.05)。结论定时定量口服水化与常规静脉水化对经皮冠状动脉介入术患者对比剂急性肾损伤的预防效果相当,且术前口服水化、术后定时定量口服水化可减轻患者胃部不适。

Objective To discuss the effect of rationed drinking on prevention of contrast induced acute kidney injury after percuta neous coronary intervention （PCI）. Methods A total of 69 patients to receive PCI were randomized into three groups of 23 ： a control group received routine intravenous hydration, an intervention group 1 were given oral hydration at regular hours and in a fixed quantity after PCI, and an intervention group 2 were asked to drink 500 mL before PCI, and then were given oral hydration at regular hours and in a fixed quantity after the procedure. The blood urea nitrogen （BUN）, serum creatinine （Scr） and cystatin C （Cys C） before and after PCI,as well as urine volume 3 h after PCI were observed. Results There were no significant differences in Scr, BUN and Cys C among the 3 groups （P〉0.05 for all）. No contrast-induced acute kidney injury was observed in the 3 groups. The urine volume 3 h after PCI of the intervention group 2 was significantly higher than the other two groups （P〈0.05,P〈 0.01）, with no significant differences found between the latter two groups. Conclusion Oral hydration at regular hours and in a fixed quantity can prevent contrast-induced acute kidney injury as well as conventional intravenous hydration. Moreover, preoperative oral hydration combined with oral hydration at regular hours and in a fixed quantity after PCI can relieve gastric discomfort in pa tients.