血管造影剂对老年缺血性脑血管病患者肾功能影响的临床观察  

Effect of contrast media on renal function in elderly patients suffering from ischemic cerebral vasculardisease and undergoing angiography

作　　者：李绍钦[1] 王凯[1] 田丰[1] 贾中芝[1] 蒋国民[1] 刘同强[1] 恽文伟[2] 

机构地区：[1]南京医科大学附属常州第二人民医院介入科,江苏常州213003 [2]南京医科大学附属常州第二人民医院神经内科,江苏常州213003

出　　处：《中华老年医学杂志》2014年第3期250-253,共4页Chinese Journal of Geriatrics

摘　　要：目的观察老年缺血性脑血管病患者血管造影中低渗非离子型造影剂对肾功能影响，并探讨引起造影剂。肾病（CIN）的危险因素。方法对老年缺血性脑血管病患者276例行选择性脑血管及双肾动脉造影，造影前6h和造影后12h应用静脉等渗生理盐水（1ml．kg^-1·h^-1）水化，所有患者均无明显心功能衰竭；检测造影前3d和造影后1d、2d和6d血肌酐、血尿素，计算肌酐清除率，分析造影剂对老年缺血性脑血管病患者血管造影肾功能影响。Logistic多因素回归分析影响CIN发生的危险因素。结果本组老年患者CIN发生率为6．9％（19/276），其中4例伴重度肾动脉狭窄于造影后1周行肾动脉成形术，余15例造影后3个月肾功能恢复至正常范围，19例患者均无需行透析治疗。19例CIN患者血肌酐、血尿素术后第1、2天明显升高，内生肌酐清除率较术前下降（P〈0．05），第6天上述指标与术前比较差异均无统计学意义（P〉O．05）。多因素Logistic回归分析显示，糖尿病、肾功能不全、重度肾动脉狭窄是CIN发生的重要危险因素。结论老年患者在充分水化后使用低渗非离子型造影剂安全性较高，发生CIN的危险因素为糖尿病、肾功能不全、重度肾动脉狭窄。Objective To investigate the effects of the low-osmolar nonionic contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography. To study the incidence and risk factors for contrast-induced nephropathy （CIN）. Methods 276 elderly patients who were going to receive selective cranial angiography and bilateral renal angiography were included. The 0.9% sodium chloride （1 ml . kg^-1 . h^-1） was administered in all patients 6 hours before and 12 hours after contrast media administration. No patients suffered from obviously congestive heart failure. The levels of serum ereatinine （Scr） and serum urea nitrogen （SUN） were measured 3 days before and at day 1, 2, 6 after the administration of contrast media respectively. Then creatinine clearance rate （Ccr） was calculated. Multivariate predictors of contrast- induced nephropathy were determined by logistic regression. Results Among the 276 patients, CIN occurred in 19 patients （6.9 %）, among whom 4 patients suffered from severe renal artery stenosis and received percutaneous transluminal renal angioplasty （PTRA） at 1 week after undergoing angiography. The renal function in the other 15 cases with CIN were recovered to baseline level 3 months after the use of contrast media. No patients underwent a maintenance hemodialysis. In the 19 patients with CIN, the levels Of SUN and Scr were higher and Ccr was lower at day 1 and 2 after angiography than before the procedure （all P ~ 0.05）, but the parameters were decreased to preoperative level at day 6 after angiography （all P〉0.05）. Logistic regression analysis showed that renal dysfunction, diabetes mellitus and severe renal artery stenosis were the major risk factors for contrast-induced nephropathy. Conclusions Low-osmoiar hop.ionic contrast used in angiography is safe for elderly patients if adequately hydrated with 0.9 % sodium chloride. The clinical risk factors forCIN are renal dysfunction, diabetes mellitus and severe ren

关 键 词：造影剂 肾功能不全 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]