不同肾功能水平冠心病患者行PCI术后3种水化方案的临床研究  

Clinical Research of Three Hydration Treatments after PCI for Patients with Coronary Heart Disease Complicated by Different Levels of Renal Function

作　　者：杨爱玲[1] 李兴德[1] 喻卓[1] 昂艳[1] 

机构地区：[1]昆明医学院第一附属医院心内科,云南昆明650031

出　　处：《昆明医学院学报》2012年第1期43-47,共5页Journal of Kunming Medical College

基　　金：云南省自然科学基金资助项目(2007C072M)

摘　　要：目的探讨3种水化方案预防不同肾功能水平病人行冠状动脉支架植入术术后造影剂相关肾损害的效果.方法将昆明医学院第一附属院2010年12月至2011年11月冠状动脉支架植入术患者120例入选,其中内生肌酐清除率≥90 mL/min者60例,内生肌酐清除率60～90 mL/min者60例,两肾功能水平各20例分成3组.A组围手术期给予普通生理盐水水化疗法,B组围手术期给予小剂量多巴胺加生理盐水水化疗法,C组围手术期给予碳酸氢钠加生理盐水水化疗法.比较2组术前、术后血肌酐、计算其内生肌酐清除率.结果 3组两水平共120例患者21例术后发生造影剂肾病;术前肾功能正常者术后24 h、48 h术后血肌酐均有升高,内生肌酐清除率均有降低;升高和降低幅度以C组最小,但和A、B组比较差异并无统计学意义(P>0.05);术前肾功能异常者术后48 h血肌酐3组比较差异有统计学意义(P<0.01),两两比较后结果示:AB、BC、AC差异均有统计学意义,其AB、BC组P<0.05、AC组P<0.01.内生肌酐清除率3组比较差异有统计学意义(P<0.05),两两比较后结果示AC、BC组P<0.05,余A、B两组差异无统计学意义(P>0.05).结论血肌酐正常的病人中有一部分潜在或已存在肾功能异常,术前应常规计算内生肌酐清除率来评价肾功能.临床可通过加强水化治疗预防不同肾小球滤过率的冠状动脉支架植入术后病人造影剂相关肾损伤.Objective To investigate the efficacy of three protective measures of kidney function （hydration treatment） during perioperative period of interventional therapy for renal function of patients with percutaneous coronary intervention （PCI） complicated by different levels of renal function. Methods The relation between three hydration therapies and renal function of 120 PCI patients were analyzed, including 60 cases with endogenous creatinine clearance quartile 90 mL/min and 60 cases with endogenous creatinine clearance rate 60 -90 mL/min. These patients were divided into three groups according to the level of renal function： in the group A, atients were treated with the hydration treatment of normal saline water during interventional perioperative period （IPP） ; in the group B, patients were treated with the hydration treatment of normal saline water plus small doses of dopamine during IPP; in the group C, patients were treated with hydration treatment of normal saline water plus low dose NaHC03 during IPP. Blood BUN, Blood Cr, 13 2-albuminuria and MG levels of all patients were measured before and after PCI. And endogenous creatinine clearance rate （Ccr） was calculated. Results 21 cases gotcontrast-induced nephropathy in 120 patients. After 24 h and 48 h postoperation, serum creatinine levels increased and endogenous creatinine clearance rate decreased significantly in the patients with preoperative normal renal function. The increase and decrease degree in group C was the minimum, Compared with the other groups, there was no significant difference in statistics （P 〉 0.05）. Blood serum creatinine, endogenous creatinine clearance rate of three groups in Preoperative abnormal renal function have significant difference in statistics （ P 〈 O.01 ）. The Blood serum creatinine results of multiple comparison： BC, AC and AB has statistically significant differences： the group B and C （P 〈 0.05） , the group A and B （ P 〈 0.05）, the group A and C （ P 〈 0.01 ）. The endogeno

关 键 词：不同肾功能水平 冠状动脉支架植入术 造影剂相关性肾损害 

分 类 号：R543.3[医药卫生—心血管疾病]