早期连续性血液滤过治疗老年造影剂急性肾损伤患者的疗效观察  

To observe the efficacy of early application of continuous venovenous hemofUtration in elderly patients with contrast-induced acute kidney injury

作　　者：刘同强[1] 丁志坚[2] 李娟娟[3] 冯曦[1] 张良峰[2] 龚苏飞[1] 

机构地区：[1]南京医科大学附属常州二院肾内科,常州213003 [2]南京医科大学附属常州二院心内科,常州213003 [3]南京医科大学附属常州二院肿瘤内科,常州213003

出　　处：《中华老年医学杂志》2010年第3期222-225,共4页Chinese Journal of Geriatrics

摘　　要：目的观察造影剂导致急性肾损伤老年患者早期应用连续性血液滤过（CVVHF）治疗的疗效。方法将造影剂引起急性肾损伤老年患者36例，随机分为常规治疗组和CVVHF组，常规治疗组给予常规治疗，CVVHF组行冠状动脉造影后2．5h立即予CVVHF治疗12h；观察两组患者肾功能变化、需要暂时。肾替代治疗的发生率、冠状动脉造影临床相关事件（肺水肿、心肌梗死、休克）发生率以及住院期间病死率。结果常规治疗组造影剂肾病发生率为88．9％（16／18），CVVHF组为16．7％（3／18），差异有统计学意义（x2=18．836，P〈0．01）；常规治疗组需暂时肾替代治疗的发生率为72．2％（13／18），CVVHF组为11．1％（2／18），差异有统计学意义（x2=13．829，P〈0．01）；常规治疗组造影临床相关事件发生率为83．3％（15／18），CVVHF组为22．2％（4／18），差异有统计学意义（x2=13．486，P〈0．01）；常规治疗组住院病死率为16．7％（3／18），CVVHF组为5．6％（1／18），差异无统计学意义（x2=1．125，P〉O．05）。结论早期应用CVVHF治疗老年患者冠状动脉造影后引起的急性肾损伤，可以有效地阻止造影剂对肾功能的损害，并可明显改善患者的预后。Objective To observe the efficacy of early application of continuous venovenous hemofiltration （CVVHF） in elderly patients with contrast-induced acute kidney injury （AKI）. Methods A total of 36 elderly inpatients with contrast induced AKI were randomly divided into two groups： CVVHF group （n= 18） and routine treatment group （n= 18）. The renal function, the incidences of contrast-induced nephropathy （CIN）, in-hospital events （pulmonary edema, myocardial infarction and shock）, temporary renal-replacement therapy and in-hospital mortality were observed. Results The incidence of CIN was higher in routine treatment group than in CVVHF group [88.9 % （16/18） vs. 16.7% （3/18）, P〈0. 053. Temporary renal-replacement therapy was required in 13（72.2%） patients of routine treatment group and in 2（11.1%） patients of CVVHF group （P〈 0.05）. The rate of in-hospital events was higher in routine treatment group than in CVVHF group [83.3 % （15/18） vs. 22.2%（4/18）, P 〈 0. 013 . In-hospital mortality rate was higher in routine treatment group than in CVVHF group [16.7%（3/18） vs. 5.6%（1/18）, P〈0.05]. Conclusions Early application of CVVHF in patients with contrast induced AKI after percutaneous coronary intervention appears to be effective in preventing the deterioration of renal function, and it could improve in-hospital outcomes.

关 键 词：肾功能不全 急性 血液滤过 造影剂 

分 类 号：R692[医药卫生—泌尿科学]