血管腔内治疗致造影剂肾病的相关危险因素分析

Analysis of risk factors related to contrast-induced nephropathy in endovascular treatment

目的探讨血管外科腔内治疗致造影剂肾病的相关危险因素。方法回顾性分析行腔内治疗患者279例的临床资料。根据腔内治疗前后肾功能的变化分为造影剂肾病组、非造影剂肾病组。比较2组性别、年龄、体重、合并症(高血压、糖尿病、冠心病)、主要诊断、造影剂类型、剂量、术前肾功能及个人造影剂限量超量使用情况,分析腔内治疗致造影剂肾病的相关危险因素。结果279例腔内治疗患者发生造影剂肾病37例(13.3%),3例需临时血液透析治疗。单因素分析结果显示,2组性别、主要诊断、造影剂类型、剂量、术前肾功能及个人造影剂限量超量使用差异有统计学意义(P<0.05);多因素回归分析结果显示,个人造影剂限量超量使用是腔内治疗术后造影剂肾病的危险因素(P<0.05)。结论个人造影剂限量超量使用是腔内治疗发生造影剂肾病的独立危险因素,发病风险是未超量使用者的3.8倍;术前应个体化计算造影剂限量,避免超量使用,对超量患者应采取更积极的预防措施。

Objective To investigate the risk factors related to contrast-induced nephropathy(CIN)in endovascular surgery.Methods The clinical data of 279 patients who underwent endovascular surgery were retrospectively analyzed.According to the changes of renal function before and after endovascular treatment,they were divided into CIN group and non-CIN group.The gender,age,weight,comorbidities(hypertension,diabetes,coronary heart disease),major diagnosis,type and dose of contrast,preoperative renal function,and excessive use of contrast compared,and the risk factors for CIN in endovascular treatment were analyzed.Results There were 37 cases(13.3%)of CIN in 279 patients during endovascular treatment,and 3 cases required temporary hemodialysis treatment.The univariate analysis showed significant difference between two groups with respect to gender,major diagnosis,type and dose of contrast,preoperative renal function,and excessive use of contrast(P<0.05).Multivariate regression analysis showed that the excessive use of contrast was a risk factor for CIN after endovascular treatment(P<0.05).Conclusion Excessive use of contrast is an independent risk factor for CIN in endovascular treatment,and the risk of disease onset is 3.8 times that of non-overdose users.The maximal acceptable contrast dose should be calculated individually before surgery to avoid over-use,and preventive measures should be taken more actively for patients with overdose.