改进水化方案预防对比剂肾病的效果  

Effect of hydration improvement to prevent contrast induced nephropathy

作　　者：刘文娟[1] 夏勇[2] 沈莹[3] 

机构地区：[1]徐州医学院研究生学院,221006 [2]徐州医学院附属医院心内科,221006 [3]徐州医学院徐州临床学院心内科,221009

出　　处：《中华现代护理杂志》2013年第18期2117-2121,共5页Chinese Journal of Modern Nursing

基　　金：基金项目：徐州市“双百”科研课题资助项目（BRA201125）

摘　　要：目的探讨改进水化方案预防对比剂肾病（CIN）的效果。方法选择住院行择期冠状动脉造影和（或）介入术中属CIN中高危风险患者160例，采用RichardDoll随机分配表将患者随机分为对照组与改进组，各80例。术前8h行简化盐负荷试验，术后对照组持续24h按1．5m1．kg～·h“速度静脉输注0．9％氯化钠溶液；改进组持续24h静脉输注0．9％氯化钠溶液，期间根据患者尿量、隐性失水量、血压、心率和外周静脉压反馈调整补液量和速度，维持患者血容量动态平衡。比较两种水化方法预防CIN的效果。结果两组患者术前输液量、术后24h饮水量比较差异无统计学意义（P〉0．05）；术后24h输液量及尿量对照组分别为（2314．21±295．03），（1918．25±297．58）ml，改进组分别为（2781．69±254．72），（2245．50±278．31）ml，两组比较差异均有统计学意义（t值分别为10．727，7．184；P〈0．01）；对照组术前NT-ProBNP与改进组比较差异无统计学意义（P〉0．05）；术后对照组NT—ProBNP（2882．16±2724．24）ng／ml明显高于改进组（1507．16±1473．84）ng／ml，差异有统计学意义（Z=1．975，P〈0．05）；改进组CIN发生率2．5％，对照组发生率12．5％，两组比较差异有统计学意义（X2=5．766，P=0．016）；CIN患者术后24，48，72h的血肌酐（Scr）浓度高于非CIN患者；CIN患者尿NGAL浓度在术后各时间点均高于术前，并在24～48h达到峰值，较血Scr升高提前24h；两组患者术后发生急性肺水肿、尿潴留及术后住院时间比较差异均无统计学意义（P〉0．05）；两组患者均未出现血液透析及死亡病例。结论量出为人的改进水化方案能在减少CIN发生的同时有效保护心功能。Objective To discuss the effect of hydration improvement to prevent contrast induced nephropathy （CIN）. Methods 160 patients with CIN of high risks who had received coronary arteriongraphy were chosen and Richard Doll was used to divide them into the control group and the improvement group, each with 80 cases. The control group had 0. 9% NaCl for 24 h with the speed of 1. 5ml/kg·h, while the improvement group had 0. 9% NaCl for 24 h and their fluid volume and speed was adjusted according to patients＇ urine volume, recessive loss, blood pressure, heart rate and peripheral venous pressure to maintain dynamic equilibrium of blood volume. Effect in two groups was compared. Results There was no statistically significant difference of preoperative infusion volume and postoperative drinking volume in 24 hours between two groups （ P 〉 0.05 ）. Postoperative 24 h infusion volume and urine volume were （2 314.21±295.03 ） and （ 1 918.25±297.58） in the control group, （2 781.69±254.72） and （2 245.50±278.31 ） in the improvement group, and the differences were statistically significant （t = 10. 727,7. 184, respectively; P 〈 0.01 ）. There was no statistically significant difference of preoperative NT-ProBNP between two groups （P 〉 0.05）. Postoperative NT-ProBNP was （2 882. 16 ±2 724.24）ng/ml in the control group and （1 507.16 ＋ 1 473.84）ng/ml in the improvement group, and the difference was statistically significant （Z = 1. 975, P 〈0.05）. Incidence rate of CIN was 12.5% in the control group and 2.5% in the improvement group, and the difference was statistically significant （X2 = 5. 766, P =0.016）. Scr in the blood 24, 48 and 72 hours after surgery was higher in CIN patients than that in non-CIN patients. NGAL in urine was higher after the surgery than before, and reached its peak during 24 -48 hours, 24 hours ahead of Scr increase. There was no statistically significant difference of acute lung edema, urinary retention and hospitalization time between two groups （

关 键 词：对比剂肾病 水化方案 心功能保护 

分 类 号：R692[医药卫生—泌尿科学]