老年慢性肾衰竭患者对比剂所致急性肾损伤的预防性血液净化研究

Prophylactic blood purification for contrast-induced acute kidney injury in elderly patient with chronic renal failure

目的了解间断静静脉血液滤过(intermittent venovenous hemofiltation,IVVH)预防老年慢性肾衰竭患者对比剂所致急性肾损伤(contrast-induced acute kidney injury,CI-AKI)的应用现状,探讨IVVH对老年慢性肾衰竭患者CI-AKI的预防作用。方法回顾性分析2014年6月~2015年12月于北京医院心内科行冠状动脉造影检查和/或经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的39例老年(≥60岁)慢性肾衰竭患者相关临床资料。按照PCI术后是否行预防性血液净化措施,将患者分为IVVH组和非IVVH组,比较组间对比剂所致急性肾损伤发生率及相关临床资料。结果 39例老年慢性肾衰竭患者,年龄(74.03±7.65)岁;IVVH组18例,非IVVH组21例。18例PCI术后行IVVH慢性肾衰竭患者:高血压肾病8例、糖尿病肾病3例、缺血性肾病2例、其他肾脏病5例;术前血肌酐(188.83±76.68)mmol/L,术前肾小球滤过率评估(estimated glomerular filtration rate,e GFR)(30.89±12.38)ml/(min·1.73m^2),含碘对比剂用量(176.67±69.11)ml;IVVH参数:血流速(155.56±9.84)ml/min,血滤置换液流速(29.73±6.42)ml/(kg·h),每次超滤量386.72±265.75ml。IVVH组和非IVVH组CI-AKI发生率分别为5.56%、42.86%,组间存在统计学差异(χ~2=5.252,P=0.022,)。结论 PCI术后行IVVH可能是降低老年慢性肾衰竭患者CI-AKI发生的有效措施。

Objective To investigate the effect of intermittent venovenous hemofiltration （IVVH） for the prevention of contrast-induced acute kidney injury （CI-AKI） in elderly patients with chronic renal failure （CRF） as well as the current situation about this clinical issue. Methods A total of 39 elderly （t〉60 years old） CRF patients treated with coronary angiography and/or percutaneous coronary intervention （PCI） in Beijing Hospital during the period from Jun. 2014 to Dec. 2015 were retrospectively studied. There were divided into IVVH group （with preventive IVVH after PCI） and non-IVVH group （without preventive IVVH after PCI）. The prevalence of CI-AKI and its related clinical data were compared between the two groups. Results The average age was 74.03±7.65 years old in the 39 elderly CRF patients, of whom 18 were in the IVVH group and 21 in the non-IVVH group. In the 18 patients in IVVH group, the primary diseases for CRF were hypertensive nephropathy （n=8）, diabetic nephropathy （n=3）, ischemic nephropathy （n=2）, and other renal diseases （n=5）; before PCI, serum cretinine was 188.83±76.68 mmol/1, and eGFR was 30.89±12.38 ml/（min· 1.73m2）; the average iodinated contrast agent used was 176.67±69.11 ml; the parameters of IVVH used were blood flow rate 155.56±9.84 ml/min, hemofiltration fluid replacement rate 29.73±6.42 ml/（kg,h）, and ultrafiltration vol- ume 386.72 ±265.75 ml/time. The prevalence of CI-AKI was 5.56% in IVVH group and was 42.86% in non- IVVH group （x^2=5.252, P=0.022）. Conclusions Preventive IVVH after PCI is probably an effective measure to reduce the prevalence of CI-AKI in elderly patients with chronic renal failure.