五苓散联合前列地尔预防冠心病患者经皮冠状动脉介入术后造影剂肾病发生率的影响

Effect of Wuling Powder Combined with Alprostadil on Incidence of Contrast-Induced Nephropathy in Patients with Coronary Heart Disease after Percutaneous Coronary Intervention

目的探讨中药五苓散加减联合前列地尔预防冠心病患者经皮冠状动脉介入术后造影剂肾病发生率的影响。方法将本院2017年1月—2018年1月期间收治的100例冠状动脉介入手术治疗患者采用随机数字法将其分为研究组(50例)和对照组(50例)。给予对照组前列地尔及水化治疗,研究组在对照组治疗基础之上加用五苓散煎剂口服。术前、术后24 h、术后72 h分别比较两组接受冠状动脉介入手术治疗的肾功能包括血肌酐、尿素氮、肾小球滤过率的情况,造影剂肾病发生情况和不良反应情况。结果术前两组患者血肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(e GFR)差异无统计学意义(P> 0.05);患者治疗后24 h,两组血肌酐、尿素氮水平差异具有统计学意义,治疗后72 h,肾小球滤过率水平差异具有统计学意义(P <0.05);研究组患者术后发生造影剂肾病1例,发生率为2%(1/50);对照组患者术后发生造影剂肾病7例,发生率为14%(7/50),经统计分析,两组差异具有统计学意义(P <0.05);治疗后,研究组发生肝酶异常2例、腹痛1例、恶心1例,共5例;对照组研究组发生肝酶异常5例、腹泻2例、腹痛8例、恶心3例,总共14例,两组差异具有统计学意义(P <0.05)。结论临床中应用五苓散加减联合前列地尔对可以对于冠状动脉介入手术之后患者肾功能起到较为理想的保护作用,能有效预防患者造影剂肾病的发病,可进行临床推广应用。

Objective To investigate the effect of Modified Wuling Powder combined with alprostadil on the incidence of contrast-induced nephropathy in patients with coronary heart disease after percutaneous coronary intervention. Methods A total of100 patients with coronary artery interventional surgery admitted to our hospital from January 2017 to January 2018 were randomly divided into study group and control group with 50 cases in each group. The control group was given alprostadil and hydration therapy,while the study group was given Wuling Powder orally on the basis of the control group. The renal function including serum creatinine( Scr),urea nitrogen( BUN) and glomerular filtration rate( e GFR),incidence of contrast-induced nephropathy and adverse reactions were compared between the two groups before treatment,24 and 72 hours after coronary intervention. Results There was no significant difference in Scr,BUN or e GFR between the two groups before operation( P > 0. 05). There was significant difference in Scr and BUN between the two groups 24 hours after treatment. There was significant difference in e GFR 72 hours after treatment( P < 0. 05). There was 1 case of contrast-induced nephropathy occurred in the study group and the incidence was2%( 1/50). There were 7 cases of contrast-induced nephropathy occurred in the control group and the incidence was 14%( 7/50). there was significance between two groups( P < 0. 05). After treatment,there were 2 cases of abnormal hepatic enzymes,1 case of abdominal pain and 1 case of nausea in the study group,and 5 cases of abnormal hepatic enzymes,2 cases of diarrhea,8 cases of abdominal pain and 3 cases of nausea in the control group. There were significant differences between the two groups( P <0. 05). Conclusion The clinical application of Wuling Powder and alprostadil can protect renal function of patients after coronary artery interventional surgery,effectively prevent the occurrence of contrast-induced nephropathy,and can be widely used in clinic.