造影剂肾病17例临床分析

Clinical Analysis of 17 Patients with Contrast-induced Nephropathy.

目的探讨造影剂肾病(CIN)的危险因素,并寻求预防造影剂引起的这一并发症的有效方法。方法本研究对2004年6月至2005年12月在广州医学院第二附属医院诊断为造影剂肾病的17例患者资料行回顾性分析。所用造影剂为低渗非离子型的 Iopamidol(碘帕醇,商品名碘必乐),剂量70～150 mL。造影前及造影后第2、第7天化验血肌酐(Scr)。结果所有患者造影后第2天 Scr 平均升高(82.35±99.10)μmoL/L,第7天11例患者 Scr 降至正常水平(103.82±20.49)μmol/L,6例患者 Scr 值仍高(437.83±335.85)μmol/L,其中3例患者需行血液透析治疗。结论 CIN 的危险因素包括原有肾功能不全,充血性心力衰竭,大剂量使用造影剂,糖尿病,应用肾毒性药物等。肾功能减退的患者应尽量减少造影剂用量。利尿剂和其它肾毒性药物至少在造影前后24小时停用。静脉补液和血液滤过可预防 CIN。

Objective To determine the risk factors of Contrast-induced Nephropathy(CIN)and discuss means of minimizing the risk or preventing this complication.Methods A retrospective analysis of the data of 17 patients who were confirmed CIN in The Second Affiliated Hospital of Guzngzhou Medical College from 2004.6-2005.12 was admin- istrated.The contrast medium was lopamidol,doses varied from 70 mL to 150 mL.Serum creatinine(Scr)was meas- ured before and day 2,day 7 after angiography.Results Scr elevation of all the patients was 82.35±99.10μmol/Lat day 2.Scr of 11 patients returned to normal at day 7(103.82±20.49)μmol/L,the other 6 still remain high level (437.83±335.85)μmol/L and 3 of them needed hemodialysis therapy.Conclusion Risk factors of CIN include baseline Scr elevation,congestive heart failure,diabetes,high doses of contrast medium and concomitant use of nephro- toxic drugs.Contrast medium should be used at the minimal dose necessary in patients preexisting renal impairment.Di- uretics and other nephrotoxic drugs should be withheld for at least 24 hours before and after exposure to contrast medium. Additional fluids and hemofiltration should be given to prevent CIN.