强化口服水化预防急性心肌梗死患者急诊经皮冠状动脉介入治疗后发生造影剂肾病的作用

Effect of strengthening oral hydration to prevent contrast-induced nephropathy after emergency percutaneous coronary intervention in patients with acute myocardial infarction

目的探讨不同口服水化方案对急性心肌梗死(acute myocardial infarction,AMI)患者行急诊经皮冠状动脉介入(percutaneous coronary interventions,PCI)治疗后造影剂肾病(contrast-induced nephropathy,CIN)发生的影响。方法选择2015年7月至2018年4月广东省人民医院心血管内科监护室收治的AMI行急诊PCI治疗患者378例,随机分为强化口服水化组(实验组)108例和常规水化组(对照组)270例。两组均在就诊即刻、急诊PCI治疗后24 h、48 h及72 h测定血肌酐值、尿素氮浓度,计算相应估算肾小球滤过率;急诊PCI治疗后72 h比较两组CIN、术后心功能不全等发病率。结果实验组6 h口服水量为(934±317)mL,对照组6 h口服水量为(307±172)mL。两组造影剂用量比较,差异无统计学意义[(99±30)mL vs.对照组(104±31)mL,P>0.05]。两组24 h静脉总入量比较,差异无统计学意义[(743±391)mL vs.(823±450)mL,P>0.05]。急诊PCI治疗后72 h内CIN发病率:实验组11例,发病率10.19%;对照组59例,发病率21.85%,两组CIN发病率比较,差异有统计学意义(P<0.01)。结论 AMI急诊PCI治疗后6 h应用强化口服水化方案可有效减少急诊PCI治疗后CIN的发病率,并且口服量是安全可行的。

Objectives To investigate the effects of different oral hydration regimens on the occurrence of contrastinduced nephropathy (CIN) after emergency percutaneous coronary interventions (PCI) in patients with acute myocardial infarction(AMI).Methods Totally 378 patients with AMI who underwent emergency PCI admitted to the Cardiovascular Department in Guangdong Provincial People′s Hospital from July 2015 to April 2018 were randomly divided into two groups.Among them,108 patients were in intensive oral hydration group(experimental group)and 270 patients were in conventional hydration group(control group).Serum concentrations of creatinine and urea nitrogen were measured immediately after treatment and 24 h,48 h,72 h after emergency PCI in both groups.The estimated glomerular filtration rate was calculated.Incidence of CIN and postoperative cardiac insufficiency were calculated in both groups 72 hours after emergency PCI.Results The average oral water volume in experimental group were(934±317)mL,which in control group was(307±172)mL.There was no significant difference in the amount of contrast agent usage between the two groups: The experimental group was(99±30)ml while the control group was(104±31)ml(P>0.05).There was no statistically significant difference in 24-hour total venous volume between the two groups[(743±391)mL vs.(823±450)mL,P>0.05].Incidence of CIN within 72 hours after emergency PCI was 11 cases in experimental group(10.19%)and 59 cases in control group(21.85%).Incidence of CIN was statistically significant between the two groups(P<0.01).Conclusions The 6-hour oral hydration regimen for patients with AMI after emergency PCI is safe and feasible,which can effectively reduce the incidence of CIN after emergency PCI.