水化方案对冠状动脉介入术后造影剂肾病的临床疗效

Clinical effect of hydration regimen on contrast-induced nephropathy after percutaneous coronary intervention

目的探讨水化方案对冠状动脉介入术后造影剂肾病的临床疗效。方法本研究为前瞻性研究,选取新余市人民医院2017年1月至2021年1月应用碘佛醇造影剂行冠状动脉介入150例患者,按照随机数字表法分为水化治疗组和常规治疗组,每组各75例,年龄40~75岁。(1)水化治疗组:在接受冠脉造影及血管介入治疗患者术前6 h静脉给予0.9%氯化钠溶液,滴速为1 ml/(kg·h),直至术后12 h。(2)常规治疗组:冠脉造影患者术后给予0.9%氯化钠溶液500 ml静滴,冠脉造影及冠状动脉介入术患者术后给予0.9%氯化钠溶液1000 ml静滴。观察血肌酐水平、β_(2)微球蛋白水平变化情况、造影剂肾病发生情况。结果水化治疗组和常规治疗组术前1 d血肌酐水平对比,差异无统计学意义(P>0.05);常规治疗组术后2 d、术后1个月血肌酐水平均高于术前1 d(P<0.001);水化治疗组术前1 d、术后2 d、术后1个月血肌酐水平对比,差异无统计学意义(P>0.05);水化治疗组术后2d、术后1个月血肌酐水平低于常规治疗组同时期(P<0.001);水化治疗组和常规治疗组术前1 dβ_(2)微球蛋白水平对比,差异无统计学意义(P>0.05);常规治疗组术后2 d、术后1个月β_(2)微球蛋白水平均高于术前1 d(P<0.05);水化治疗组术前1 d、术后2 d、术后1个月β_(2)微球蛋白水平对比,差异无统计学意义(P>0.05);水化治疗组术后2 d、术后1个月β_(2)微球蛋白水平低于常规治疗组同时期(P<0.001);水化治疗组CIN发生率低于常规治疗组(P<0.001)。结论水化方案能够提升冠状动脉介入术后造影剂肾病的临床预后,能够改善患者的血肌酐水平、β_(2)微球蛋白水平变化情况,降低CIN发生率。

Objective To investigate the clinical effect of hydration regimen on contrast-induced nephropathy after percutaneous coronary intervention.Methods This study was a prospective study.A total of 150 patients(aged 40-75 years)who underwent percutaneous coronary intervention(PCI)with iodophor contrast agent in Xinyu People's Hospital from From January 2017 to January 2021 were selected and randomly divided into hydration treatment group(n=75)and conventional treatment group(n=75),aged 40-75 years.(1)Hydration treatment group:0.9%sodium chloride solution was intravenously administered at a rate of 1 ml/(kg·h)6 hours before surgery until 12 hours after surgery in patients undergoing coronary angiography and vascular intervention therapy.(2)Conventional treatment group:patients undergoing coronary angiography were given 500 ml of 0.9%sodium chloride solution intravenously after surgery,and patients undergoing coronary angiography and coronary intervention(PCI)were given 1000 ml of 0.9%sodium chloride solution intravenously after surgery.The changes of serum creatinine level,β_(2) microglobulin level and the occurrence of contrast-induced nephropathy(CIN)were observed.Results There was no significant difference in blood creatinine level between the hydration treatment group and the conventional treatment group 1 day before surgery(P>0.05).The serum creatinine level 2 days after the operation and 1 month after operation in the conventional treatment group were higher than that 1 day before the operation(P<0.001).The difference between serum creatinine levels 1 day before the operation,2 days after the operation,and 1 month after operation in the hydration treatment group was not significant(P>0.05).The serum creatinine level 2 days after operation and 1 month after operation in the hydration treatment group was lower than that at the same time in the conventional treatment group(P<0.001).The preoperative 1 dβ_(2) microglobulin levels of the hydration treatment group and the conventional treatment group were not significantly different(P>0.05).The levels of β_(2) microglobulin in the conventional treatment group 2 days after operation and 1 month after operation were higher than those on the 1 day before operation(P<0.001).There was no significant difference in β_(2) microglobulin levels in the hydration treatment group 1 day before the operation,2 days after the operation,and 1 month after operation(P>0.05).The β_(2) microglobulin level at 2 days after the operation and 1 month after operation in the hydration treatment group was lower than that in the conventional treatment group in the same period(P<0.001).The incidence of CIN in the hydration therapy group was lower than that in the conventional therapy group(P<0.001).Conclusion Hydration regimen has a good clinical effect on contrast-induced nephropathy after percutaneous coronary intervention.It can improve the changes in serum creatinine level and β_(2) microglobulin level and reduce the incidence of CIN.