冠状动脉介入治疗并发造影剂肾病的影响因素及护理对策

Influencing factors and nursing strategies of contrast-induced nephropathy after percutaneous coronary intervention

目的探讨冠状动脉介入治疗(PCI)后并发造影剂肾病(CIN)的影响因素及护理方法。方法选择2016年10月至2017年11月期间在山东省立第三医院接受PCI术患者1 459例,其中并发CIN者160例(CIN组),未并发CIN者1 299例(非CIN组),选取可能相关的因素在两组之间进行对比分析,并将具有统计学差异的因素进行Logistic回归分析以探讨PCI并发CIN的危险因素,同时分析其有效护理措施。结果 CIN组与非CIN组患者在年龄<65岁、吸烟、高血压、糖尿病、急性心肌梗死、不稳定性心绞痛、慢性肾功能不全、心功能不全和造影剂用量方面比较差异均具有统计学意义(P<0.05);经Logistic回归分析发现,年龄<65岁、吸烟、高血压、糖尿病、急性心肌梗死、慢性肾功能不全、心功能不全、造影剂用量较大为PCI治疗并发CIN的独立危险因素(P<0.05)。结论 CIN是PCI治疗后严重的并发症之一,年龄<65岁、吸烟、高血压、糖尿病、急性心肌梗死、慢性肾功能不全、心功能不全、造影剂用量是独立危险因素,对于高危人群,术前应给予充分的危险因素评估,给予针对性、系统化护理措施,以降低CIN的发生率。

Objective To explore the influencing factors and nursing strategies of contrast-induced nephropathy（CIN） after percutaneous coronary intervention（PCI）. Methods A total of 1 459 patients who underwent PCI at Shandong Provincial Third Hospital during October 2016 and November 2017 were divided into the CIN group（n=160）and the non-CIN group（n=1 299）. The possible related factors were selected for comparative analysis between the two groups, and the statistically significant factors were used for Logistic regression analysis to explore the risk factors of CIN after PCI. The effective nursing measures were analyzed. Results Statistically significantly differences in age65 years, smoking, hypertension, diabetes, acute myocardial infarction, unstable angina, chronic renal insufficiency, cardiac insufficiency and contrast media dosage were observed between CIN group and non-CIN group（P0.05）. Logistic regression analysis found that age65 years, smoking, hypertension, diabetes, acute myocardial infarction, chronic renal insufficiency, cardiac insufficiency and large dosage of contrast media were the independent risk factors of CIN after PCI（P0.05）. Conclusion CIN is one of the serious complications after PCI. Age65 years old, smoking, hypertension, diabetes, acute myocardial infarction, chronic renal insufficiency, cardiac insufficiency and contrast media dosage are independent risk factors. For high-risk groups, adequate risk factors should be evaluated before operation, and targeted, systematic nursing measures should be given to reduce the incidence of CIN.