对比剂肾病对行急诊经皮冠状动脉介入治疗的急性心肌梗死患者预后的影响

Effect of contrast-induced nephropathy on prognosis of patients with acute myocardial infarction performed emergency percutaneous coronary intervention

目的了解对比剂对行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性心肌梗死患者肾功能的影响,探讨对比剂肾病(contrast-induced nephropathy,CIN)的相关因素及对患者预后的影响。方法选择2015年1月至2016年4月在海口市人民医院心内科接受急诊PCI治疗的心肌梗死患者141例,均采用碘海醇为造影剂。测定介入治疗前、后患者肾功能的变化,并记录住院期间的主要不良事件。结果141例患者中,24例发生CIN,发病率为17.02%。CIN组左心室射血分数(left ventricular ejection fraction,LVEF)<40%患者比例和对比剂使用量显著高于非CIN组,差异有统计学意义(P<0.05)。CIN组主要不良事件[心肺复苏、室性心动过速、心室颤动;快速心房颤动;高度传导阻滞需要临时起博;急性肺水肿;呼吸衰竭需要机械通气;心源性休克需行主动脉内球囊反搏(intra aortic balloon pump,IABP);再发心肌梗死]发生率均高于非CIN组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示年龄、前壁心肌梗死、再灌注时间及造影剂用量是CIN的独立危险因素。结论急性心肌梗死患者行急诊介入治疗后CIN发病率较高,年龄、前壁心肌梗死、再灌注时间及造影剂用量是CIN的独立危险因素,CIN会增加患者住期间的不良事件和病死率,应基于以上危险因素采取相应措施降低CIN的发病率。

Objectives To investigate the effect of contrast agent on renal function of patients with acute myocardial infarction （AMI） performed emergency percutaneous coronary intervention （PCI）, and to explore the related factors of contrast-induced nephropathy （CIN） and the piognosis of patients. Methods Totally 141 patients with AMI performed emergency PCI were enrolled from January 2015 to April 2016 in Haikou People＇s Hospital. Iodinated alcohol was used as contrast agent in all these patients. Changes of renal function before and after intervention were measured and adverse events during hospitalization were recorded. Results CIN occurred in 24 （17.02%） out of 141 patients. Percentage of patients with left ventricular ejection fraction （LVEF）〈40% and amount of contrast agents in CIN group were significantly higher than those in non-CIN group （P〈0.05）. Incidence of major adverse events including cardiopulmonary resuscita- tion, ventricular tachyeardia, ventricular fibrillation; atrial fibrillation; height block requiring temporary pacemaker; acute puhnonary edema; respiratory failure requiring mechanical ventilation; cardiogenic shock needing intra aortic balloon pump （IABP） ; recurrent myocardial infarction was significantly higher in CIN group than that in non-CIN group （P〈0.05）. Multivariate Logistic regression analysis indicated that age, anterior wall myocardial infarction, reperfusion duration and contrast agent dosage were independent risk factors for CIN. Conclusions Incidence of CIN was higher in patients with AMI after emergency intervention. Age, anterior wall myocardial infarction, repeffusion duration and contrast agent were independent risk factors for CIN. CIN increases adverse events and mortality of patients during the inhospital period. Appropriate measures should be taken to reduce the incidence of CIN based on the above risk factors.