生物阻抗向量分析对冠状动脉造影术患者水化的指导价值

Value of bioimpedance vectorial analysis in hydration guidance in patients undergoing coronary angiography

目的探索生物阻抗向量分析(BIVA)对冠状动脉造影术(CAG)患者水化的指导价值,为临床提供实用的、可操作性强的客观指标,减少对比剂相关急性肾损伤(CI-AKI)的发生。方法采用便利抽样法,选取2023年8-10月该院心血管内科首次行CAG的72例住院冠心病患者,收集患者基本信息,采集血生化、血氨基端前脑钠肽(NT-ProBNP),使用BIVA获得患者术前身体水分情况;收集实验室数据和对比剂用量信息。使用SPSS27.0软件分析患者术前身体水分情况与术后肌酐水平、肾小球滤过率(eGFR)、CI-AKI发生的相关性。通过公式计算本研究身体总水分推荐范围(90%概率)。结果CAG患者术前测定的身体总水分与术后第1天的eGFR呈弱正相关(相关系数0.19,P=0.02);身体总水分与术后第1天肌酐水平呈弱负相关(相关系数-0.23,P<0.01),与术后第3天肌酐水平呈弱负相关(相关系数-0.24,P=0.04),与术后CI-AKI发生呈中度负相关(相关系数-0.35,P<0.01);体水分占比与术后第3天eGFR呈轻度正相关(相关系数0.22,P=0.01)。以CAG患者不发生CI-AKI为目标,本研究身体总水分推荐范围(90%概率)为不低于33.25 L。结论BIVA对CAG患者水化具有指导意义。

Objective To explore the guiding value of bioimpedance vector analysis(BIVA)in the hydration of the patients undergoing coronary angiography(CAG)in order to provide the practical and strongly operable objective indicators for clinical practice reducing the occurrence of contrast agent-related acute renal injury(CI-AKI).Methods The convenience sampling method was used to select 72 inpatients with coronary heart disease who underwent CAG for the first time in the department of cardiovascular medicine in this hospital from August to October 2023.The basic information of the patients was collected,the blood biochemistry and N-terminal pro-brain natriuretic peptide(NT-ProBNP)were collected,and the preoperative body moisture situation was obtained by BIVA.The laboratory data and contrast agent dosage were extracted from LIS system and nursing document system.The SPSS27.0 software was used to analyze the correlation between preoperative body water and postoperative creatinine level,glomerular filtration rate(eGFR),CI-AKI.The recommended range of total body water in this study was calculated by the formula(90%probability).Results The total body moisture measured before operation in the patients with CAG had weakly positive correlation with eGFR on postoperative 1 d(r=0.19,P=0.02).The total body moisture had weakly negative correlation with creatinine on postoperative 1 d(r=-0.23,P<0.01),slightly negative correlation with creatinine on postoperative 3 d(r=-0.24,P=0.04),and moderately negative correlation with postoperative CI-AKI occurrence(r=-0.35,P<0.01);the proportion of body water had slightly positive correlation with eGFR on postoperative 3 d(r=0.22,P=0.01).With the no occurrence of CI-AKI in the patients with CAG as the target,according to the formula calculation,it is suggested that the total body moisture range(90%probability)of this study should not be less than 33.25 L.Conclusion BIVA is of guiding significance for the hydration of the patients with CAG.