不同连续肾脏替代治疗方法对经皮冠状动脉介入治疗的冠心病合并慢性肾功能不全患者的临床疗效分析  

Effects of CRRT Started at Different Time on the Outcomes of Percutaneous Coronary Intervention in Patients with Chronic Renal Dysfunction

作　　者：张近波[1] 许国斌[1] 董美平[1] 朱金强[1] 史朝红[1] 鄢来超[1] 曹烈祥[1] 吴仙丹[1] 

机构地区：[1]温州医学院附属温岭医院,温岭市第一人民医院EICU,浙江省温岭市317500

出　　处：《中国全科医学》2013年第32期3857-3858,3862,共3页Chinese General Practice

摘　　要：目的对比分析不同连续肾脏替代治疗(CRRT)方法对行经皮冠状动脉介入治疗(PCI)的冠心病合并慢性肾功能不全患者的疗效。方法选择2008年1月—2012年1月在温岭市第一人民医院住院且病历资料完整的行PCI的慢性肾脏疾病(CKD)患者42例,按随机数字表法分为A、B两组,每组21例。A组在行PCI后24 h开始行CRRT;B组在行PCI前8 h及行PCI后24 h均行CRRT。对比两组患者急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、造影剂肾病(CIN)发生率及血肌酐水平。结果两组患者的性别、年龄及入院时APACHEⅡ评分间差异均无统计学意义(P>0.05)。与A组比较,B组患者CIN发生率降低(P<0.05)。A组患者PCI后24 h血肌酐水平高于PCI前(t=2.759,P<0.05),PCI前及PCI后48、72 h血肌酐水平间差异均无统计学意义(t=1.223、0.272,P>0.05);B组患者PCI后24 h血肌酐水平与PCI前间差异无统计学意义(t=0.554,P>0.05),PCI后48、72 h血肌酐水平低于PCI前(t=3.764、2.517,P<0.05)。结论 PCI前、后均行CRRT较仅在PCI后行CRRT能更有效地减少CIN的发生率。Objective To explore the effects of continuous renal replacement therapy （CRRT） started at different time on the efficacy of percutaneous coronary intervention （PCI） in patients with chronic renal dysfunction （CRD）. Methods A total of 42 CRD patients undergoing PCI in the First People＇s Hospital of Wenling between January 2008 and January 2012 were included in the study, and they were divided into two groups randomly ： Group A （ treated with CRRT only at 24 hours after PCI, n =21 ） and Group B （treated with CRRT at 8 hours before PCI and 24 hours after PCI, n =21 ）. The level of ereatinine, the incidence of contrast induced nephropathy （ CIN）, and the scores of acute physiology and chronic health evaluation I1 （ A- PACHE ]] ） were compared between the two groups. Results There was no significant difference in age, gender, and APACHE l] at admission between the two groups （ P 〉 0. 05 ）. The incidence of CIN was significantly lower in Group B than those in Group A （ P 〈 0. 05 ）. In Group A, the level of creatinine was significantly lower after 24 hours of PCI than that before PCI （ t = 2. 759, P 〈 0. 05）, but no difference was found between the level of creatinine before PCI and those after 48 hours and 72 hours of PCI （t = 1. 223, P 〉 0. 05 ; t = 0. 272, P 〉 0. 05 ） ; In Group B, the levels of creatinine were significantly lower after 48 hours and 72 hours of PCI than that before PCI （ t = 3. 764, P 〈 0. 05 ; t = 2. 517, P 〈 0. 05 ）, but no difference was found between the level of creatinine before PCI and that after 24 hours of PCI （ t = 0. 554, P 〉 0. 05 ）. Conclusion CRRT performed before and after PCI is more effective in preventing the further deterioration of renal function and reducing the incidence of CIN compared to CRRT performed only after PCI in CRD patients.

关 键 词：造影剂 肾病 肾替代疗法 

分 类 号：R692[医药卫生—泌尿科学]