研究以下腔静脉塌陷率为基础指导水化治疗预防介入术后造影剂肾病的临床应用价值

Study on the Clinical Application Value of Hydration Therapy Based on the Collapse Rate of Inferior Vena Cava to Prevent Contrast Nephropathy after Interventional Surgery

目的研究以下腔静脉塌陷率为基础指导水化治疗预防介入术后造影剂肾病的临床应用价值。方法选取2021年11月—2023年11月四川省岳池县人民医院收治的460例行冠状动脉造影术(CAG)或者经皮冠状动脉介入术(PCI)患者作为研究对象,按照随机数表法将所有患者分成对照组(232例)和观察组(228例),对照组实施传统方法指导的水化治疗,观察组通过测量下腔静脉塌陷率(CI-IVC)来指导水化治疗,比较两组患者手术前后的血肌酐(SCr)、内生肌酐清除率(eGFR)、血清同型半胱氨酸(CysC)、尿素氮(BUN)、超敏C反应蛋白(hs-CRP)、血清N末端B型利钠肽前体(NT-proBNP)水平;造影剂总量、水化总量;左室射血分数(LVEF)、左室舒张末期内径(LVEDD);造影剂肾病。结果术前,两组患者的SCr、eGFR、CysC、BUN、hs-CRP、NT-proBNP水平比较,差异无统计学意义(P>0.05)。两组患者的LVEF、LVEDD比较,差异无统计学意义(P>0.05)。术后,观察组的SCr、eGFR、CysC、BUN、hs-CRP、NT-proBNP水平均优于对照组,差异有统计学意义(P<0.05);两组患者的造影剂总量比较,差异无统计学意义(P>0.05);观察组患者的水化总量明显高于对照组,差异有统计学意义(P<0.05);观察组造影剂肾病发生率低于对照组,差异有统计学意义(P<0.05)。结论通过测量下腔静脉塌陷率来指导患者做水化治疗,可有效降低造影剂肾病的发生率,值得临床应用。

Objective To study the clinical application value of hydration therapy based on the collapse rate of Inferior vena cava to prevent contrast nephropathy after interventional surgery.Methods A total of 460 patients undergoing coronary angiography(CAG)or percutaneous coronary intervention(PCI)in our hospital from November 2021 to November 2023 were selected and divided into control group(n=232)and observation group(n=228)according to random number table method.The control group received hydration therapy guided by traditional methods.The observation group was guided by the measurement of inferior vena cava collapse rate(CI-IVC).The serum creatinine(SCr),endogenous creatinine clearance(eGFR),serum homocysteine(CysC),urea nitrogen(BUN),hypersensitive C-reactive protein(hs-CRP)and serum N-terminal B-type natriuretic peptide precursor(NT-proBNP)of the two groups were compared before and after surgery.Total contrast agent,total hydration;Left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD).Contrast agent nephropathy.Results Before surgery,there was no statistically signifi cant diff erence in the levels of SCr,eGFR,CysC,BUN,hs CRP,and NT proBNP between the two groups of patients(P>0.05).There was no statistically signifi cant diff erence in LVEF and LVEDD between the two groups of patients(P>0.05).After surgery,the SCr,eGFR,CysC,BUN,hs CRP,NT proBNP water levels in the observation group were signifi cantly higher than those in the control group(P<0.05).There was no statistically signifi cant diff erence in the total amount of contrast agent between the two groups of patients(P>0.05).The total amount of hydration in the observation group was significantly higher than that in the control group,with statistical signifi cance(P<0.05).The incidence of contrast-enhanced nephropathy in the observation group was signifi cantly reduced compared to the control group,with a signifi cant diff erence(P<0.05).Conclusion Guiding patients to do hydration therapy by measuring the collapse rate of inferior vena cava can eff ectively reduce the incidence of contrast agent nephropathy,which is of high application value and worth popularizing.