低渗非离子对比剂对经皮血管成形并支架置入治疗脑梗死患者肾功能的影响

The effect of low permeability nonionic contrast media on renal function in patients with cerebral infarction treated by percutaneous transluminal angioplasty and stenting

目的研究低渗非离子对比剂,对经皮血管成形并支架置入治疗脑梗死患者肾功能的影响。方法选取90例行经皮血管成形并支架置入治疗的脑梗死患者进行研究。根据患者治疗前肾功能状况(内生肌酐清除率<60 m L/min即为肾功能不全),分为肾功能正常组65例和肾功能不全组25例。患者均应用低渗非离子造影剂,分析比较造影前后肾功能状况(肌酐、肌酐清除率)及对比剂肾病发生率。结果肾功能正常组的65例患者中,造影剂肾病发生率为3.08%(2/65);肾功能不全组患者25例患者中,对比剂肾病发生率为24.00%(6/25),2组患者造影剂肾病发生率差异有统计学意义(P<0.05)。造影前后,肾功能正常组患者肌酐及肌酐清除率差异无统计学意义(P>0.05);造影后,肾功能不全患者的肌酐水平明显升高(P<0.05),肌酐清除率均显著降低(P<0.05)。结论在肾功能正常的脑梗死患者中,应用低渗非离子对比剂行经皮血管成形并支架置入治疗不影响肾能损害,但在已经存在肾功能损伤者,低渗非离子对比剂会加重肾功能损害,导致造影剂肾病发生。

Objective To study the effect of low permeability nonionic contrast media on renal function in patients with cerebral infarction treated with percutaneous transluminal angioplasty and stenting. Methods 90 cases of percutaneous angioplasty and stent placement in the treatment of patients with cerebral infarction were studied. According to the condition of renal function before treatment （creatinine clearance rate 〈 60 mL/min is renal insufficiency）, the patients were divided into normal renal function group （n = 65 ） and renal insufficiency group （n = 25）. All patients were treated with hypotonic nonionic contrast agent, and the renal function （ creatinine, creatinine clearance rate） and the incidence of contrast induced nephropathy were analyzed. Results The incidence of contrast induced nephropathy in the 65 patients with normal renal function group was 3.08% （2/65） ; the incidence of contrast induced nephropathy in the 25 cases with renal insufficiency group was 24% （6/25）. Comparedring these two groups, the contrast nephropathy incidence had sig- nificant difference （ P 〈 0.05 ）. In the normal renal function group, the creatinine and creatinine clearance rate were no significant differ- ence before and after using the contrast, （P 〉 0.05 ） ;in the renal insufficiency group, however, creatinine level were significantly in- creased after using the contrast （ P 〈 0.05 ）, and the creatinine clearance rate was significantly lower after angiography （ P 〈 0.05 ）. Conclusion The low osmolar nonionic contrast medium don＇ t affect the renal function in the patients with normal renal function, but can affect the renal function and increases incidence of contrast nephropathy patients with renal dysfunction during the performance of percutaneous angioplasty.