伽马刀治疗过程中对比剂肾损伤的防治  

Prevention and treatment of contrast-induced acute kidney injury occurred during gamma-ray stereotactic radiosurgery

作　　者：杨黄[1] 倪志明[1] 陆春来[1] 

机构地区：[1]上海解放军第八五医院肾脏科,200052

出　　处：《介入放射学杂志》2012年第9期743-746,共4页Journal of Interventional Radiology

摘　　要：目的分析伽马刀治疗过程中急性肾损伤(AKI)的发病机制和危险因素,观察水化等干预治疗的防治作用。方法收集2007年10月至2011年5月住院接受伽马刀治疗的体部肿瘤患者,其中100例(对照组)按照常规流程进行,100例(十预治疗组)采用水化、碱化、钙凋等预防措施。观察两组AKI发生率、临床过程及转归。结果对照组有18例AKI患者,均发生在造影后1～5 d,3例因少尿、高分解状态或高钾而进行血液透析1～3次。2周后所有患者的肾功能逐步改善,4周恢复至术前水平。干预治疗组有5例AKI,均发生在造影后48 h内,与对照组比较差异有统计学意义(P<0.05)。与对照组相比,干预治疗组AKI表现较轻,无少尿,血清肌酐(Scr)、尿素氮(BUN)和尿酸升高,肾小球滤过率降低的变化幅度较低,1周时已恢复至术前水平,两组间差异有统计学意义(P<0.05)。多元回归分析显示,高血压、糖尿病、高脂血症和Scr基础值偏高与AKI的发生密切相关;与年龄、性别和伽马刀治疗部位无显著相关性。结论伽马刀治疗过程巾发生的AKI主要与对比剂有关,而非放射性损伤所致。伴有糖尿病、高血压、高血脂、Scr基础值偏高者尤易发生。积极防治肾血管收缩能够防止和减轻AKI的发生和发展。Objective To investigate the mechanisms and the risk factors of contrast-induced acute kidney injury （AKI） occurred during gamma-ray stereotaetie radiosurgery, and to discuss the prevention and treatment of AKI in the tumor patients receiving stereotaetic radiosurgery （gamma knife） treatment. Methods A total of 200 patient with body tumors, who were admitted to authors＇ hospital during the period from Oct. 2007 to May 2011 to receive gamma knife treatment, were enrolled in this study. The patients were divided into treatment group （n = 100） and control group （n = 100）. Routine therapeutic procedure was performed in the patients of control group, while certain preventive measures such as hydration, alkalization, calmodulin calcium-regulation, etc. were carried out in the patients of study group. The occurrence of AKI, the clinical condition and outcomes as well as the therapeutic effect were documented. The resuhs were analyzed. Results In the control group, 18 patients developed AKI within 1 - 5 days after the use of contrast media. Three patients had to receive hemodialysis for 1 - 3 times due to oliguria, or high decomposition state, or hyperpotassemia. The renal function was gradually improved in two weeks and returned to preoperative state in four weeks in all patients. In the treatment group, AKI occurred in 5 patients within 48 hours after angiography. The difference in the occurrence of AKI between the two groups was statistically significant （P 〈 0.05）. In the treatment group, the manifestation of AKI was less severe and no oliguria was seen. The elevation of serum creatinine, blood urea nitrogen （BUN） and uric acid was mild, and the reduction degree of glomerular filtration rate （GFR） was not severe. And all the above changes returned to preoperative levels in one week. The differences in the above mentioned items between the two groups were statistically significant （P 〈 0.05）. Multiple regression analysis indicated that the presence of hypertension, diabetes as wel

关 键 词：急性肾损伤 立体定向放射治疗 危险因素 

分 类 号：R692[医药卫生—泌尿科学]