北京某三甲医院血管外科患者对比剂使用现状分析

Analysis of current situation of contrast agent use in vascular surgery patients of a third-class hospital in Beijing

目的 分析首都医科大学宣武医院血管外科患者对比剂使用现状及使用后导致急性肾损伤(AKI)发生的原因,优化临床使用对比剂前后的AKI预防方案。方法 选取该院血管外科2021年3月和7月使用对比剂进行介入造影和CTA的患者,依据《2018年欧洲泌尿生殖放射学会造影后急性肾损伤防治指南》进行评估。结果 共纳入患者207例,进行了335次造影,发生5例AKI(2.4%),对比剂超剂量使用的患者有36例(17.4%)。在院期间进行了≥2次造影的患者有101例(48.8%),其中有56例(27.1%)患者在两次造影期间未进行肌酐检查;207例患者使用对比剂中有87例(42.0%)造影前后水化剂量不足。结论 临床在造影过程中应注意对比剂的使用剂量、使用间隔,在对比剂使用前后规范水化方案,完善血肌酐检测,以减少AKI的发生。

Objective To analyze the current situation and the causes of acute renal injury(AKI) after interventional angiography and CT angiography(CTA) in vascular surgery patients in Xuanwu Hospital of Capital Medical University,and to optimize the AKI prevention program before and after clinical use of contrast agents. Methods The patients in the vascular surgery department of the hospital who used contrast agents for interventional angiography and CTA in March and July 2021 were selected and analyzed According to the 2018 European Society of Urogenital Radiology Guidelines for the Prevention and Treatment of Acute Renal Injury after Angiography. Results A total of 207 patients were included in the study and 335 times of angiography were performed. A total of 5 patients(2. 4%) had AKI. 36 patients(17. 4%) had used the contrast agent in excess of the dose. There were 101 patients(48. 8%) had undergone more than two angiography in the hospital,of which 56 patients(27. 1%) had not undergone creatinine examination during the two angiography;Among 207 patients,87(42. 0%) had insufficient hydration dose before and after contrast media. Conclusion The dosage and interval of contrast agent should be paid attention to in the course of clinical contrast,the hydration scheme should be standardized before and after the use of contrast agent,and the detection of blood creatinine should be improved to reduce the occurrence of AKI.