等渗与低渗造影剂对老年肾功能损伤患者行冠脉造影术的安全性临床观察

Safety Analysis of Isotonic and Hypotonic Contrast Media for Coronary Angiography in Elderly Patients with Renal Impairment

目的:探讨等渗与低渗造影剂对老年肾功能损伤患者行冠脉造影术的安全性。方法:选择本院2017年3月至2019年3月收治的行冠脉造影术的肾功能损伤患者163例。轻度肾功能损伤的92例患者中,等渗组46例,低渗组46例;中度肾功能损伤的71例患者中,等渗组36例,低渗组35例。所有患者均给予0.9%氯化钠注射液水化治疗,由同一组医生进行冠脉造影术,低渗组给予碘海醇注射液,等渗组给予碘克沙醇注射液。分别统计轻度肾功能损伤者和中度肾功能损伤者采用等渗或低渗造影剂后血肌酐(Scr)和内生肌酐清除率(Ccr)水平的变化,以及CIN的发生率。结果:轻度肾功能损伤者中,等渗组和低渗组应用造影剂后,Scr和Ccr水平在术后24 h和72 h均呈上升趋势,术后7 d和14 d均呈下降趋势(P<0.05)。中度肾功能损伤者中,等渗组和低渗组应用造影剂后,Scr和Ccr水平在术后24 h和72 h均呈上升趋势,术后7 d和14 d均呈下降趋势(P<0.05),但等渗组在术后24 h、72 h时Scr水平显著低于低渗组,术后24 h、72 h和7 d时Ccr水平显著低于低渗组(P<0.05)。轻度和中度肾功能损伤者中,等渗组CIN的发生率虽然低于低渗组,但两组差异无统计学意义(P>0.05)。结论:对于轻度肾功能损伤患者,采用低渗和等渗造影剂所带来的肾功能毒性并无显著差异;对于中度肾功能损伤患者,采用等渗造影剂所带来的肾功能毒性更小。

Objective:To investigate the safety of isotonic and hypotonic contrast media in coronary angiography for elderly patients with renal function injury.Methods:From March 2017 to March 2019,163 patients with renal impairment underwent coronary angiography were selected.Of 92 patients with mild renal function injury,46 were in isotonic group,46 were in hypotonic group,36 were in isotonic group and 35 were in hypotonic group.All patients were treated with 0.9%sodium chloride injection.Coronary angiography was performed by the same group of doctors.Iohexol injection was given to hypotonic group,and ioxanol injection was given to isotonic group.The changes of serum creatinine(Scr)and endogenous creatinine clearance(Ccr)levels and the incidence of CIN in patients with mild and moderate renal impairment after using isotonic or hypotonic contrast media were analyzed.Results:In patients with mild renal injury,the levels of Scr and Ccr in the isotonic and hypotonic groups were increased at 24 h and 72 h,and decreased at 7 d and 14 d after surgery(P<0.05).In patients with moderate renal injury,the levels of Scr and Ccr in the isotonic and hypotonic groups were increased at 24 h and 72 h,and decreased at 7 d and 14 d after surgery(P<0.05),but the Scr level of isotonic group was significantly lower than that of hypotonic group at 24 h and 72 h,and the Ccr level at 24 h,72 h and 7 d was significantly lower than that of hypotonic group(P<0.05).In patients with mild and moderate renal impairment,the incidence of CIN in the isotonic group was lower than that in the hypotonic group,but the difference between the two groups was not statistically significant(P>0.05).Conclusion:For patients with mild renal function injury,there is no significant difference in renal function toxicity between hypotonic and isotonic contrast media,and for patients with moderate renal function injury,isotonic contrast media has less renal function toxicity.