不同水化疗程对急诊经皮冠状动脉介入术后对比剂肾病预防效果的对比观察

Comparative Observation on Preventive Effects of Different Hydration Therapy on Contrastinduced Nephropathy After Emergency Percutaneous Coronary Intervention

目的:对比观察不同水化疗程对急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后对比剂肾病(contrast induced nephropathy,CIN)的预防效果。方法:对2015年3月—2016年6月丹江口市第一医院123例急诊行PCI术患者资料进行回顾性分析,根据水化疗程的不同分为3组,每组各41例。PCI术前,3组患者均静脉滴注0.9%氯化钠注射液进行水化,滴注速度1 ml/(kg·h)[左心室射血分数不足30%者,滴注速度0.5 ml/(kg·h)],手术结束后,A、B、C 3组患者分别持续水化6、12、24 h。比较3组患者CIN发生率及血肌酐(Scr)、血尿素氮(BUN)、肌酐清除率(Ccr)、肾小球滤过率(GFR)水平。结果:术后48 h,C组患者CIN发生率为2.44%(1/41),显著低于A组的24.39%(10/41)及B组的14.63%(6/41),差异均有统计学意义(P<0.05);C组患者Scr、BUN、Ccr、GFR水平均显著优于A、B组,差异均有统计学意义(P<0.05)。结论:急诊PCI术后给予24 h水化疗法可有效保护患者的肾功能、预防CIN。

OBJECTIVE： To compare and observe the preventive effects of different hydration therapy on contrastinduced nephropathy（ CIN） after emergency percutaneous coronary intervention（ PCI）. METHODS： Retrospective analysis was conducted on data of 123 cases with emergency PCI aditted into the First Hospital of Danjiangkou Hospital from Mar.2015 to Jun. 2016,according to different hydration therapy,patients were divided into three groups,with 41 cases in each.Before PCI,all patients were treated with intravenous 0. 9% sodium chloride injection,with dripping speed of 1 ml /（ kg·h）[patients with left ventricular ejection fraction lower than 30%,the dripping speed was 0. 5 ml/（ kg·h） ]. After surgery,continuous hydration was conducted on group A,B and C for 6 h,12 h and 24 h. The incidence of CIN,serum creatinine（ Scr）,blood urea nitrogen（ BUN）,creatinine clearance rate（ Ccr） and glomerular filtration rate（ GFR） of three groups were compared. RESULTS： After surgery of 48 h,the incidence of CIN in group C was 2. 44%（ 1 /41）,significantly lower than that of group A[24. 39%（ 10 /41） ]and group B[14. 63%（ 6 /41） ],with statistically significant difference（ P〈0. 05）. The Scr,BUN,Ccr,GFR of group C were significantly better than those of group A and group B,with statistically significant difference（ P〈0. 05）. CONCLUSIONS： Patients after emergency PCI with 24 h hydration therapy can effectively protect patients＇ renal function and prevent the CIN.