术后短时间血液滤过对慢性肾病患者对比剂肾病的预防

Short-term hemofiltration for prevention of contrast induced nephropathy in patients with stage 3 or stage 4 chronic kidney disease after

目的评估慢性肾病(CKD)3期和4期患者在行经皮冠状动脉介入治疗(PCI)后行床旁短时间血液滤过(血滤)对比剂肾病(CIN)的发生率以及临床疗效。方法回顾性分析2012年2月至2017年12月在南京大学医学院附属鼓楼医院心脏科因冠心病合并CKD 3期和4期需行PCI,且术后行床旁血滤的患者共78例。术后即刻开始床旁血滤,检测术前、术后第1天、第3天、第30天的血肌酐值,并根据Cockcroft 和 Gault equation 公式计算肌酐清除率(CrCl)。以术后CIN的发生率作为主要观察指标,术后30 d主要严重不良临床事件(包括再发心绞痛、心肌梗死、心脏性猝死、缺血性和出血性卒中)作为次要观察指标。结果 78例患者平均年龄(73.31±1.54)岁,男性60例(76.9%),冠心病分型中稳定型心绞痛12例(15.4%),不稳定型心绞痛42例(53.8%),急性非ST段抬高型心肌梗死24例(30.8%),CKD 3期34例(43.6%),CKD 4期44例(56.4%);平均血滤持续时间(7.36±0.77)h,术前、术后第1天、第3天、第30天血肌酐值分别为(211.77±20.63)μmol/L、(165.18±10.50)μmol/L、(201.00±15.60)μmol/L、(212.65±24.10)μmol/L,CrCl分别为(32.62±2.09)ml/min、(40.96±2.06)ml/min、(34.48±2.12)ml/min、(32.26±2.08)ml/min,术后未出现CIN。随访第30天主要严重不良临床事件发生率为4例(5.1%)。结论术后尽早开始短时间血滤能够预防CKD 3期和4期患者CIN的发生,对于CIN高危患者,提供了一种可选择的预防CIN的措施。

Objective To evaluate the effect of short-time bedside hemofiltration for the incidence of contrast induced nephropathy (CIN) and clinical effi cacy in patients with stage 3 or stage 4 chronic kidney disease (CKD) after percutaneous coronary intervention (PCI). Methods A total of 78 patients presented with coronary heart disease and stage 3 or stage 4 CKD were enrolled in Drum Tower hospital of Nanjing university between February 2012 to December 2017,whom were all received bedside hemofiltration after PCI. We performed bedside hemofiltration immediately after PCI,serum creatinine of pre-PCI,1 day,3 days and 30 days post-PCI were tested and the creatinine clearance(CrCl)were calculated based on Cockcroft and Gault equation. The primary points was the incidence of CIN,and the secondary endpoints were major adverse clinical events (MACE)including recurrent angina pectoris, recurrent myocardial infarction,cardiogenic death,ischemic and hemorrhagic stroke. Results The average age was(73.31±1.54)years old including 60 males(76.9%).12(15.4%)patients were presented with stable angina pectoris,42(53.8%)were unstable angina pectoris and 24(30.8%)were acute non- ST-segment elevation myocardial infarction. 34(43.6%)cases were stage 3 CKD and 44(56.4%) were stage 4. The mean duration of hemofiltration was(7.36±0.77)hours. Serum creatinine value pre- PCI,1 day,3 days and 30 days of post-PCI were(211.77±20.63)μmol/L,(165.18±10.50)μmol/L,(201.00±15.60)μmol/L and(212.65±24.10)μmol/L,respectively. The CrCl were(32.62± 2.09)ml/min,(40.96±2.06)ml/min,(34.48±2.12)ml/min and(32.26±2.08)ml/min, respectively. There was no CIN. There were 4(5.1%)patients met the MACE after 30 days follow-up. Conclusions Short-term hemofi ltration started as soon as possible after PCI can prevent the occurrence of CIN in patients with stage 3 or stage 4 CKD. It may provide an alternative strategy to prevent CIN in patients with high risk.