解放军第三O三医院造影剂肾病监测情况评价与用药分析

Clinical monitoring of contrast-induced nephropathy and analysis of medication in No.303 Hospital of PLA

目的:调查医师对造影剂肾病(contrast-induced nephropathy,CIN)重视度,探讨肾功能监测对造影剂肾病诊断、预防和控制的临床意义及药学服务切入点。方法:收集解放军第三O三医院2015年全年行造影检查病人152例,统计医嘱肾功能监测率。118例监测完整病人分为非CIN组(105例)和CIN组(13例),比较两组病人使用造影剂前后血肌酐、血尿素氮、内生肌酐清除率和血清胱抑素C(cystatin C)变化,分析CIN发生率、危险因素、处理措施及医嘱用药情况。结果:152例病人医嘱肾功能监测率为77.63%,病人CIN发生率为11.02%。造影前CIN组血肌酐、尿素氮、血清胱抑素C均值较非CIN组高,造影后CIN组血肌酐、尿素氮较造影前升高,差异有统计学意义(P<0.05);造影后CIN组血清胱抑素C升高、内生肌酐清除率降低,但无统计学意义。个别CIN病人医嘱用药存在不足。结论:医师对CIN重视度需进一步提高,使用造影剂前后及时监测肾功能,可有效评估造影剂对病人肾功能的影响。临床药师可加入医疗团队,积极参与CIN防治。

Objective： To investigate the awareness of clinical physicians with contrast-induced nephropathy （C1N） and also to discuss the clinical importance of renal function monitoring to the diagnosis, prevention and control of CIN, as well as practical approaches to pharmaceutical care. Methods： One hundred and fifty＇two patients who underwent angiography in No. 303 Hospital in 2015 were recruited for the study. Rate of renal function monitoring by medical advice was analyzed. One hun dred and eighteen patients with full monitoring were divided into the non-CIN group （n=105） and the CIN group （n= 13）. Levels of serum creatinine （Cr）, serum urea nitrogen （BUN）, endogenous creatinine clearance rate （Ccr） and serum cystatin C （CysC） were compared between the patients of the 2 groups, both before and after the application of the agent. The incidence of CIN, risk factors, intervention measures and medication by medical advice were analyzed. Results： The rate of renal function monitoring by medical advice in the 152 patients was 77.63%（118/152）, with the CIN incidence of 11.02%（13/118）. The av- erage levels of Cr, BUN and CysC before angiography in the patients of the CIN group were higher than those of the non CIN group. Cr and BUN levels of the CIN group after angiography were increased as compared with those before angiography, and statistical significance could be noted, when comparisons were made between them （P〈0.05）. However, after angiography, the level of CysC in the CIN group elevated and the Ccr was lowered, but without statistical significance. There were problems in the medication by medical advice in certain CIN patients. Conclusion： Clinical physicians should further heighten their aware ness with CIN. Renal function should be timely detected before and after the application of the agent, so as to effectively evalu- ate the effects of the agent on renal function. With this reason, clinical pharmacists should be a member of the medical team and actively involve in the prevention and treatment of CIN.