围手术期水化治疗联合应用呋塞米对经皮冠状动脉介入后对比剂肾病的影响及其安全性评价

Effect of perioperative hydration therapy combined with furosemide on contrast-induced nephropathy after percutaneous coronary intervention and its safety evaluation

目的探讨围手术期水化治疗联合应用呋塞米对经皮冠状动脉介入(PCI)治疗后对比剂肾病(CIN)的影响及其安全性。方法收集2023年1—12月在新疆维吾尔自治区喀什地区第一人民医院心内科行PCI术的556例患者。采用随机数字表法将所有患者分为对照组和观察组,各278例,观察组围手术期给予水化+呋塞米治疗,对照组给予单纯水化治疗。比较2组临床基本资料;比较分析术前、术后肾功能指标及CIN发生率;二元Logistic回归方法分析CIN影响因素;比较2组患者住院期间不良反应发生率。结果观察组男性比例低于对照组,高血压病史比例、对比剂用量、服用β受体阻滞剂比例高于对照组(均P<0.05)。2组术后血肌酐、胱抑素C及血尿酸水平均明显高于术前,差异均有统计学意义(均P<0.05)。观察组CIN发生率低于对照组[19.4%(54/278)比27.3%(76/278)],差异有统计学意义(P=0.027)。二元Logistic回归分析结果显示,对比剂用量是PCI术后CIN的独立危险因素(比值比=1.016,95%置信区间:1.009~1.024,P=0.019),呋塞米是PCI术后CIN的保护因素(比值比=0.359,95%置信区间:0.143~0.904,P=0.030)。2组住院期间不良反应发生率比较差异无统计学意义(P=0.102)。结论围手术期水化联合应用呋塞米可降低PCI术后CIN的发生率,且不增加患者住院期间不良反应发生率,安全性较高。

Objective To investigate the effect and safety of perioperative hydration therapy combined with furosemide on contrast-induced nephropathy(CIN)after percutaneous coronary intervention(PCI).Methods A total of 556 patients who underwent PCI in the Department of Cardiology,the First People′s Hospital of Kashi,Xinjiang Uygur Autonomous Region from January to December 2023 were collected.All patients were divided into control group and observation group by random number table method,with 278 cases in each group.The observation group was treated with hydration and furosemide during the perioperative period,and the control group was treated with hydration alone.The basic clinical data of the two groups were compared.The renal function and the incidence of CIN were compared before and after operation.The influencing factors of CIN were analyzed by binary Logistic regression.The incidence of adverse reactions during hospitalization was compared between the two groups.Results The proportion of male in the observation group was lower than that in the control group,and the proportion of hypertension history,contrast agent dosage,and proportion of takingβ-blockers were higher than those in the control group(all P<0.05).The levels of serum creatinine,cystatin C and serum uric acid in the two groups were significantly higher than those before operation(all P<0.05).The incidence of CIN in the observation group was lower than that in the control group[19.4%(54/278)vs 27.3%(76/278)](P=0.027).Binary Logistic regression analysis showed that contrast agent dosage was an independent risk factor for CIN after PCI(odds ratio=1.016,95%confidence interval:1.009-1.024,P=0.019).Furosemide was a protective factor for CIN after PCI(odds ratio=0.359,95%confidence interval:0.143-0.904,P=0.030).There was no significant difference in the incidence of adverse reactions between the two groups during hospitalization(P=0.102).Conclusion Perioperative hydration combined with furosemide can reduce the incidence of CIN after PCI,and does not increase the incidence of adverse reactions during hospitalization,with high safety.