直接冠状动脉支架置入术结合肾功能保护在并发慢性肾功能不全的冠心病中的应用  

Direct stenting and protection of renal function in patients with conorary heart disease and chronic renal insufficiency

作　　者：臧红云[1] 韩雅玲[1] 荆全民[1] 王守力[1] 邓捷[1] 刘永生[1] 

机构地区：[1]沈阳军区总医院心血管内科,沈阳110016

出　　处：《临床心血管病杂志》2004年第8期458-460,共3页Journal of Clinical Cardiology

摘　　要：目的 :评价直接冠状动脉支架置入术结合围术期肾功能保护在冠心病并发慢性肾功能不全患者中应用的安全性和疗效。方法 :将 14 4例冠心病并发慢性肾功能不全患者单盲随机分成直接支架置入术组 (Ⅰ组 ,72例 )和球囊预扩张后支架置入术组 (Ⅱ组 ,72例 ) ,两组患者围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X线曝光时间、手术时间、造影剂用量、器材消耗和肾功能情况 ,肾功能恶化通过造影剂相关性肾病 (contrastmedium associationnephropathy,CAN)发生例数来评价。结果 :Ⅰ组和Ⅱ组手术成功率均为 10 0 %。Ⅰ组X线曝光时间、手术时间、球囊导管用量及造影剂用量均低于Ⅱ组 ,4项数据两组间差异均有统计学意义 (分别为P <0 .0 5、P <0 .0 1、P <0 .0 1及P <0 .0 5 ) ;Ⅰ组术后 4 8h内血肌酐值 [(2 30 .6 2± 2 9.16 ) μmol/L]低于Ⅱ组[(2 6 8.15± 34.32 ) μmol/L],P <0 .0 1;CAN者Ⅰ组 (11例 )明显低于Ⅱ组 (2 5例 ) ,P <0 .0 1。造影剂用量、年龄及术前肾功能不全的程度均与CAN的发生有关 (均P <0 .0 1)。结论 :直接支架置入术结合围术期肾功能保护应用于冠心病并发慢性肾功能不全是一项安全有效的方法 ,不仅X线曝光时间、手术时间、球囊导管用量较少 。Objective:To evaluate the safety and efficacy of direct stenting and protection of renal function during peri-operation in patients with conorary heart disease and chronic renal insufficiency. Method:The 104 patients with coronary heart disease and chronic renal insufficiency were divided into direct stenting group ( groupⅠ) and balloon predilation group (groupⅡ) by single-blind and randomized methods. Both groups were treated with low dose dopamine plus saline hydration in order to protect renal function during peri-operation. The differences between the two groups in X-ray time, procedure's time, amount of balloon, the dose of contrast and renal function were recorded. We also observed the difference in renal function deterioration determined by the sum of CAN.Result: The procedures of coronary intervention were succeeded in all cases in two groups. The X-ray time, procedure's time, amount of balloon, the dose of contrast and the cases of CAN in groupⅠwere less than that in groupⅡ (P< 0.05, P< 0.01, P< 0.01,P< 0.05, P< 0.01,P< 0.01, respectively). CAN related with the dose of contrast, age and degree of renal insufficiency. Conclusion:Direct stenting combined with the protection of renal function during peri-operation is a safe and effective method. Not only it may save X-ray time, procedure's time, amount of balloon and the dose of contrast, but also decrease the cases of CAN by reducing the dose of contrast.

关 键 词：冠状动脉疾病 肾功能衰竭 慢性 支架 

分 类 号：R543.3[医药卫生—心血管疾病]