前列地尔联合水化治疗对老年患者经皮冠状动脉介入治疗术后对比剂肾病的预防作用

Preventive Effect of Alprostadil Combining Hydration Therapy on Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Elder Patients

目的:探讨前列地尔(前列腺素E1)联合水化治疗对老年冠心病患者行经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的预防作用。方法:选择2011-03至2014-03我院收治的175例年龄>70岁冠心病行PCI术患者纳入本研究,男122例(9.71%),平均年龄(74.7±3.9)岁,随机数字法分为两组:对照组(n=84):在常规治疗基础上,术前6 h和术后12 h给予1 ml/(kg·h)生理盐水静脉滴注水化治疗;前列地尔联合水化组(n=91):在常规治疗、水化治疗基础上,于术前1天和术后第3天静脉滴注前列地尔10μg,溶于100 ml生理盐水,2次/d。两组患者于PCI术前及术后连续3天分别测定血清肌酐水平(SCr)并计算内生肌酐清除率(Ccr),观察两组CIN的发生率。结果:Scr水平:术后第3天前列地尔联合水化组与对照组同期比较降低[(92.08±21.65)mmol/L vs(99.43±22.77)μmol/L],差异有统计学意义(P<0.05)。Ccr:术后第3天前列地尔联合水化治疗组与对照组同期比较升高[(63.78±20.58)ml/min vs(57.09±22.31)ml/min],差异有统计学意义(P<0.05)。PCI术后CIN的发生率:前列地尔联合水化组3.3%(3例)较对照组13.1%(11例)降低,差异有统计学意义(P<0.05)。结论:对于老年冠心病行PCI者,前列地尔联合水化治疗可以明显改善患者术后肾功能,降低CIN的发生。

Objective： To investigate the preventive effect of alprostadil （prostaglandin E 1） combining hydration therapy on contrast induced nephropathy （CIN） after percutaneous coronary intervention （PCI） in elder patients. Methods： A total of 175 patients with coronary artery disease （CAD） elder than 75 years received PCI in our hospital from 2011-03 to 2014-03 were retrospectively studied, those including 122/175 （69.71%） with male gender. The patients were at the mean age of （74.7 ± 3.9） years and randomly allocated into 2 groups： Control group, based on routine treatment, the patients received regular hydration of intravenous normal saline 1 ml/（kg·h） at 6 hours prior and 12 hours after PCI, n=84 and Alprostadil＋hydration group, based on routine treatment and regular hydration, the patients received intravenous alprostadil 101.tg in 100ml normal saline twice a day at 1 day prior PCI and the 3ra day after PCI, n=91. The serum levels of creatinine （SCr） were examined prior PCI and 3 days continuously after PCI, creatinine clearance rates （Ccr） were calculated and the C1N occurrence rates were compared between 2 groups. Results： At the 3rd day after PCI, the mean SCr level in Alprostadil＋hydration group （92.08 ± 21.65） gmol/L was lower than Control group （99.43 ±22.77） μmol/L, P〈0.05, the mean Ccr level in Alprostadil＋hydration group （63.78 ±20.58） ml/minwas higher than Control group （57.09 ± 22.31） ml/min, P〈0.05. The occurrence rate of CIN after PCI was higher in Control group （13.1%, 11/84 patients） than Alprostadil＋hydration group （3.3%, 3/91 patients）, P〈0.05. Conclusion： Alprostadil combining hydration therapy may obviously protect renal function and reduce the incidence rate of CIN in elder CAD patients after PCI treatment.