改良水化对ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗后造影剂相关急性肾损伤的影响

Effect of modified hydration on contrast agent⁃related acute renal injury in patients with ST⁃segment elevation myocardial infarction after percutaneous coronary intervention

目的探讨改良水化对ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗后造影剂相关急性肾损伤(CI-AKI)的影响。方法选择2020年1月—2022年12月在本院接受PCI的294例STEMI患者作为研究对象,随机分成观察组和对照组,每组各147例。对照组采用常规水化方案,观察组采用改良水化方案。观察2组患者PCI手术操作医师完成例数、支架数量、支架长度、造影剂用量、24 h静脉输液量、CI-AKI发生率和30 d内主要不良心脏事件(MACE)发生率,检测2组术前、术后24、48、72 h时血清肌酐(Scr)和估算肾小球滤过率(eGFR)。结果2组患者手术医师完成例数、支架置入数量、置入支架长度、造影剂用量、24 h静脉输液量、手术前Scr和eGFR水平等比较,差异均无统计学意义(P均>0.05)。术后2组Scr水平比较,差异有统计学意义(F_(group)=85.439,P<0.001);4个时间点间Scr水平差异有统计学意义(F_(time)=39.766,P<0.001),Scr水平组别和时间的交互效应差异存在统计学意义(F_(time×group)=8.338,P<0.001);观察组术后24、48、72 h时Scr水平低于对照组,差异均有统计学意义(F_(24h)=6.252,F_(48h)=6.198,F_(72h)=6.484,P均<0.001)。观察组CI-AKI发生率为6.8%,低于对照组的14.9%,2组差异有统计学意义(χ^(2)=4.363,P=0.038)。术后2组eGFR水平比较,差异有统计学意义(F_(group)=55.898,P<0.001);4个时间点间eGFR水平差异有统计学意义(F_(time)=26.635,P<0.001),eGFR水平组别和时间的交互效应差异存在统计学意义(F_(time×group)=5.005,P=0.001);观察组术后24、48、72h时eGFR水平高于对照组,差异均有统计学意义(F_(24h)=6.029,F_(48h)=7.128,F_(72h)=7.485,P均<0.001)。对照组和观察组患者MACE发生率比较,差异无统计学意义(χ^(2)=0.585,P=0.444)。结论改良水化方案可改善STEMI患者急诊PCI术后的肾功能,减少CI-AKI发生率,对近期MACE发生率无影响。

Objective To explore the impact of improved hydration on contrast⁃induced acute kidney injury(CI⁃AKI)in ST⁃Segment elevation myocardial infarction(STEMI)patients after emergency percutaneous coronary intervention treatment.Methods A total of 294 STEMI patients who received percutaneous coronary intervention(PCI)in our hospital from January 2020 to December 2022 were selected as the study subjects.They were divided into an observation group and a control group,with 147 cases in each group.The control group was treated with a conventional hydration scheme,and the observation group was treated with a modified hydration scheme.The number of cases completed by PCI surgeons,the length of stents,the amount of contrast agent,the intravenous infusion volume of fluid in 24 hours,the incidence of CI⁃AKI and the incidence of major adverse cardiac events(MACE)within 30 days were observed,and the serum creatinine(Scr)and estimated glomerular filtration rate(eGFR)were calculated before and at 24,48 and 72 h after operation in the two groups.Re⁃sults There were no statistically significant differences in the number of cases completed by surgeons,the number of stents inserted,the length of stents inserted,the amount of contrast agent used,the amount of 24⁃hour intravenous infusion,and the levels of preoperative Scr and eGFR between the two groups(all P>0.05).The comparison of Scr levels between the two groups after surgery showed a statistically significant differ⁃ence(F_(group)=85.439,P<0.001).There was a statistically sig⁃nificant difference in Scr levels between the four⁃time points(F_(time)=39.766,P<0.001),and there was a statistically significant difference in the interaction effect between Scr level groups and time (F_(time*group)=8.338, P<0.001). The Scr levels inthe observation group were lower than those in the control group at 24 hours, 48 hours, and 72 hours after surgery and the dif⁃ferences were statistically significant (F_(24h)=6.252, F_(48h)=6.198, F_(72h)=6.484, all P<0.001). The incidence of CI⁃AKI in the obser⁃vation group was 6.8%, lower than 14.9% in the control group, and there was a statistically significant difference between thetwo groups (χ^(2)=4.363, P=0.038). There was a statistically significant difference in eGFR levels between the two groups aftersurgery (Fgroup=55.898, P<0.001). There was a statistically significant difference in eGFR levels among the four⁃time points(Ftime=26.635, P<0.001), and there was a statistically significant difference in the interaction effect between the eGFR levelgroups and time (F_(time*group)=5.005, P=0.001). The eGFR levels in the observation group were higher than those in the controlgroup at 24 hours, 48 hours, and 72 hours after surgery and the differences were statistically significant (F_(24h)=6.029, F_(48h)=7.128, F_(72h)=7.485, all P<0.001). In the comparison of MACE incidence between the control group and the observation grouppatients, the difference was not statistically significant (χ^(2)=0.585, P=0.444). Conclusion The modified hydration regimencan improve the renal function of PCI patients with STEMI, reduce the incidence of CI⁃AKI, and have no significant effect onthe incidence of MACE in the near future.