目的探讨老年冠心病合并肾功能不全患者行冠状动脉心脏介入治疗的临床价值及可行性研究。方法回顾性分析本院心内科治疗的20例老年冠心病合并肾功能不全患者临床资料,在采用冠心病规范药物治疗基础上行冠状动脉心脏介入治疗,观察造影剂...目的探讨老年冠心病合并肾功能不全患者行冠状动脉心脏介入治疗的临床价值及可行性研究。方法回顾性分析本院心内科治疗的20例老年冠心病合并肾功能不全患者临床资料,在采用冠心病规范药物治疗基础上行冠状动脉心脏介入治疗,观察造影剂肾病（CIN）发生率及临床治疗的效果、造影剂对肾功能的损害、预后等。结果 20例患者中,单支病变4例,双支病变7例,3支病变9例,均介入成功。术前血肌酐（Scr）（184.3±31.2）mg/dl,术后48、72 h Scr分别为（189.5±30.4）mg/dl、（162.3±34.5）mg/dl;术后与术前相比,差异无统计学意义（P〉0.05）。术前肾小球滤过率（GRF）（81.2±15.1）ml/（min·1.73 m2）,术后48、72 h GRF分别为（80.9±13.1）ml/（min·1.73 m2）、（81.7±14.2）ml/（min·1.73 m2）;术后与术前相比,差异无统计学意义（P〉0.05）。随访6~9个月不等,发生不稳定型心绞痛13例（65%）,心肌梗死3例（15%）,急性左心衰竭6例（30%）。结论老年冠心病合并肾功能不全患者在充分水化疗法基础上行心脏介入治疗是可以耐受的,效果显著,值得在临床上推广。展开更多
Objective To investigate the preventive effect of contrast induced nephropathy （CIN） in elderly patients of coronary heart disease with renal insufficiency after percutaneous coronary intervention （PCI） treated by...Objective To investigate the preventive effect of contrast induced nephropathy （CIN） in elderly patients of coronary heart disease with renal insufficiency after percutaneous coronary intervention （PCI） treated by atorvastatin. Methods 300 elderly coronary heart disease patients with renal insufficiency accepted PCI in Tianjin Chest Hospital were randomly divid-ed into conventional treatment group（n=150） and intensive treatment group（n=150）.Patients in the two groups were given ator-vastatin 10mg and 40mg respectively before PCI and 72h after PCI. The level of blood urea nitrogen （BUN）， serum creatinine （Scr）， creatinine clearance rate （Ccr）， interleukin-6（IL-6），β2-microglobulin（β2-MG）， C-reactive protein（CRP）， alanine aminotransferase （ALT） were measured at admission and 72h after the procedure. Results 1The incidence of CIN in the in-tensive treatment group was 2.7%； the incidence of CIN in the conventional treatment group was 8.7%（χ2=5.05，P<0.05）.2There was no statistical difference in the levels of BUN， Scr， Ccr， IL-6，β2-MG， CRP before PCI （P>0.05）. The level of β2-MG， CRP and IL-672h after PCI was higher than before PCI （P<0.05）.372h after the procedure， the level of IL-6，β2-MG， CRP were lower in intensive treatment group than the conventional treatment group， and the level of Ccr was higher in intensive treatment group. Conclusion The administration of intensive atorvastatin before PCI has good preventive effect in elderly coronary heart disease patients with renal insufficiency. The protection mechanism may have relationship with the anti-inflamma-tion effect.展开更多
文摘目的探讨老年冠心病合并肾功能不全患者行冠状动脉心脏介入治疗的临床价值及可行性研究。方法回顾性分析本院心内科治疗的20例老年冠心病合并肾功能不全患者临床资料,在采用冠心病规范药物治疗基础上行冠状动脉心脏介入治疗,观察造影剂肾病（CIN）发生率及临床治疗的效果、造影剂对肾功能的损害、预后等。结果 20例患者中,单支病变4例,双支病变7例,3支病变9例,均介入成功。术前血肌酐（Scr）（184.3±31.2）mg/dl,术后48、72 h Scr分别为（189.5±30.4）mg/dl、（162.3±34.5）mg/dl;术后与术前相比,差异无统计学意义（P〉0.05）。术前肾小球滤过率（GRF）（81.2±15.1）ml/（min·1.73 m2）,术后48、72 h GRF分别为（80.9±13.1）ml/（min·1.73 m2）、（81.7±14.2）ml/（min·1.73 m2）;术后与术前相比,差异无统计学意义（P〉0.05）。随访6~9个月不等,发生不稳定型心绞痛13例（65%）,心肌梗死3例（15%）,急性左心衰竭6例（30%）。结论老年冠心病合并肾功能不全患者在充分水化疗法基础上行心脏介入治疗是可以耐受的,效果显著,值得在临床上推广。
文摘Objective To investigate the preventive effect of contrast induced nephropathy （CIN） in elderly patients of coronary heart disease with renal insufficiency after percutaneous coronary intervention （PCI） treated by atorvastatin. Methods 300 elderly coronary heart disease patients with renal insufficiency accepted PCI in Tianjin Chest Hospital were randomly divid-ed into conventional treatment group（n=150） and intensive treatment group（n=150）.Patients in the two groups were given ator-vastatin 10mg and 40mg respectively before PCI and 72h after PCI. The level of blood urea nitrogen （BUN）， serum creatinine （Scr）， creatinine clearance rate （Ccr）， interleukin-6（IL-6），β2-microglobulin（β2-MG）， C-reactive protein（CRP）， alanine aminotransferase （ALT） were measured at admission and 72h after the procedure. Results 1The incidence of CIN in the in-tensive treatment group was 2.7%； the incidence of CIN in the conventional treatment group was 8.7%（χ2=5.05，P<0.05）.2There was no statistical difference in the levels of BUN， Scr， Ccr， IL-6，β2-MG， CRP before PCI （P>0.05）. The level of β2-MG， CRP and IL-672h after PCI was higher than before PCI （P<0.05）.372h after the procedure， the level of IL-6，β2-MG， CRP were lower in intensive treatment group than the conventional treatment group， and the level of Ccr was higher in intensive treatment group. Conclusion The administration of intensive atorvastatin before PCI has good preventive effect in elderly coronary heart disease patients with renal insufficiency. The protection mechanism may have relationship with the anti-inflamma-tion effect.
