合并慢性肾功能不全的冠心病介入治疗术中造影剂用量与肾功能不全的相关性研究

Relationship Between Dosage of Contrast and Renal Insufficiency in Patients With Coronary Artery Disease and Chronic Renal Insufficiency

目的 :研究合并慢性肾功能不全的冠心病介入治疗术中造影剂用量与肾功能不全的相关性 ,并探讨造影剂相关性肾病 (CAN)发生的临床易患因素。方法 :10 4例合并慢性肾功能不全的冠心病患者单盲随机分为直接置入支架术 (Ⅰ组 ,n =5 2 )和预扩张后置入支架术 (Ⅱ组 ,n =5 2 )。两组患者围手术期接受小剂量多巴胺加水化疗法进行肾功能保护 ,观察两组间造影剂用量、肾功能情况、X线曝光时间和手术时间及球囊导管 ,分析高龄、术前肾功能不全的程度、心功能及糖尿病对术后肾功能恶化的影响。肾功能恶化通过CAN发生例数来评价。结果 :Ⅰ组和Ⅱ组全部手术成功。Ⅰ组造影剂用量、X线曝光时间、手术时间及球囊导管用量均低于Ⅱ组 ,4项数据两组间均有显著性差异 ;Ⅰ组术后 48h内血清肌酐值 (2 62± 0 3 3mg/dl)低于Ⅱ组 (3 0 1± 0 40mg/dl) ,P <0 0 1;CAN者Ⅰ组 (8例 )明显低于Ⅱ组 (19例 ) ,P <0 0 1。 2 7例CAN者中造影剂用量的多少与CAN之间有显著差异 (P <0 0 1) ,高龄与CAN的发生有关 (P <0 0 1) ,术前肾功能不全的程度与CAN的发生有关 (P <0 0 1) ,心功能NYHAⅡ～Ⅲ级CAN发生例数明显高于NYHAⅠ级 (P <0 0 1) ,糖尿病CAN发生例数明显高于非糖尿病 (P <0 0 1)。结论

Objective: To evaluate the relationship between the dosage of contrast and renal insufficiency in patients with coronary artery disease(CAD) and chronic renal insufficiency,and the risk factor of contrast medium associated nephropathy(CAN).Methods: One hundred and four patients with CAD and chronic renal insufficiency were divided into primary stenting group(groupⅠ,n =52) and secondary stenting group (groupⅡ,n =52) by single blind and randomized methods. Both groups were treated with low dose dopamine plus saline hydration in order to protect renal function during perioperation. The differences were recorded between groups in the doses of contrast,renal function,x-ray exposure time,and procedure time,sum of predilation balloon. The relativity was analyzed between CAN and the doses of contrast,age,degree of renal insufficiency,congestive heart disease (CHD),and diabetes,respectively. The renal function deterioration was determined by the incidence of CAN.Results:All the procedures of were successful in both groups. The doses of contrast,x-ray exposure time,procedure time,sum of predilation balloon,and the incidence of CAN in groupⅠwere less than those in groupⅡ. CAN was correlated with doses of contrast,age,degree of renal insufficiency and CHD, and diabetes.Conclusion: The doses of contrast should be controlled during coronary intervention in order to reduce CAN in patients with CAD and chronic renal insufficiency. The doses of contrast was lower by primary stenting than secondary stenting. The larger dose of contrast,ageing,degree of renal insufficiency and CHD,and presence of diabetes were all the risk factor of CAN.