透析在慢性肾功能不全冠心病患者介入治疗中的作用  

Hemodialysis during interventional therapy for coronary artery disease patients complicated by chronic renal insufficiency

作　　者：翟红霞[1] 李良[1] 殷亚昕[1] 刘润梅[1] 张津津[1] 陈海威[1] 夏云峰[1] 

机构地区：[1]解放军总医院第一附属医院干一科,北京100037

出　　处：《中华老年多器官疾病杂志》2012年第1期22-25,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的 探讨透析在合并慢性肾功能不全的冠心病患者行介入治疗时的有效性和安全性.方法 选择合并慢性肾功能不全的冠心病患者,PCI术前给予水化和碱化：连续口服碳酸氢钠片1g,3次/d×3d,术前3～12h内静脉缓慢输入氯化钠1000～1500ml,3～10ml/（ kg·h）.PCI术后留置动脉穿刺鞘管,立即进行4h的透析治疗保护肾功能,观察手术前后肾功能的变化.结果 所有患者均成功进行了冠状动脉介入治疗,术后1个月内无明显手术并发症,未出现支架内血栓.58例患者中有56例血浆肌酐水平与术前比较无明显变化,1例患者血浆肌酐升高,1例患者术后需要永久性透析.结论 合并肾功能不全的冠心病患者并非是介入治疗的禁忌症.透析可以有效的预防造影剂相关性肾病的发生,安全地进行介入治疗.Objective To explore the safety and efficacy of hemodialysis treatment during percutaneous interventional（PCI） therapy for coronary artery disease patients complicated by chronic renal insufficiency. Methods Patients with coronary heart disease combined with chronic renal dysfunction were selected. For all patients, hydration and alkalization were performed by giving continuous oral administration of sodium bicarbonate tablets lg（three times daily, for 3 days） and intravenous infusion of sodium chloride 1000~ 1500ml within 3-12 hours before PCI operation, 3 ~ 10ml/（kg ~ h）. After PCI treatment, indwelling of femoral artery puncture sheath tube was kept and patients were transferred to the dialysis room immediately and underwent 4 hours of dialysis treatment to protect renal function. Changes in renal function were analyzed. Results All patients underwent PCI treatment successfully. No obvious complication or stent thrombosis was detected within one month after PCI. Among 58 cases, 56 showed no significant increase in plasma creatinine levels compared with those before operation; one patient showed increased plasma creatinine level; one patient required permanent dialysis. Conclusion Interventional therapy is not an absolute contraindication for patients with coronary heart disease combined with renal dysfunction. Interventional treatment can be performed safely when the renal function of patients are protected adequately.

关 键 词：透析 肾功能不全 介入治疗 冠心病 造影剂相关性肾病 

分 类 号：R541.4[医药卫生—心血管疾病] R692.5[医药卫生—内科学]