碳酸氢钠水化预防心肌梗死急诊经皮冠状动脉介入术后发生造影剂肾病分析  

Effect of sodium bicarbonate on preventing contrast-induced nephropathy in patients with myocardial infarction undergoing primary percutaneous coronary interventions

作　　者：谢刚[1] 曹树军[1] 张银[1] 胡硕强[1] 王峙峰[2] 

机构地区：[1]首都医科大学大兴医院心血管内科,北京102600 [2]解放军总医院心血管内科,北京100853

出　　处：《解放军医学院学报》2015年第7期683-686,690,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的评价标准碳酸氢钠水化方案是否能有效降低ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)急诊经皮冠状动脉介入术(percutaneous coronary interventions,PCI)后造影剂肾病(contrast-induced nephropathy,CIN)的发生率。方法连续入选2013年10月1日-2014年10月1日首都医科大学大兴医院心血管内科监护室收治的以急诊PCI为初始再灌注策略的STEMI患者87例。随机分为碳酸氢钠水化组(SB组)和对照组(NSB组)。两组均在就诊即刻、急诊PCI术后24 h、48 h及72 h测定血肌酐、血钾、N末端-脑利钠肽前体(NT-pro BNP)、动脉血p H值及动脉血标准碳酸氢盐浓度,计算相应肾小球滤过率估算值。急诊PCI术后72 h统计两组CIN、低钾血症、代谢性碱中毒的发生率。结果 43例纳入SB组,剩余44例纳入NSB组。SB组1.4%碳酸氢钠溶液平均用量为(583.2±87.7)ml,急诊PCI术中两组造影剂用量差异无统计学意义[SB:(237±95)ml vs NSB:(249±102)ml,P>0.05],急诊PCI术后72 h内CIN发生率显著低于NSB组(4.7%vs 22.7%,P<0.05),两组NT-pro BNP峰值[SB:(1 275.3±116.9)pg/ml vs NSB:(1 238.9±135.4)pg/ml,P>0.05]及低钾血症发生率(SB:14.0%vs NSB:9.1%,P>0.05)、代谢性碱中毒发生率(SB:11.6%vs NSB:6.8%,P>0.05)差异无统计学意义。结论应用指南推荐的标准碳酸氢钠水化方案,能有效减少STEMI患者急诊PCI术后CIN的发生率,且并不增加该类患者低钾血症、代谢性碱中毒的发生率,额外摄入的碳酸氢钠溶液并未使STEMI患者心功能进一步恶化。Objective To investigate whether hydration with sodium bicarbonate reduces the incidence of contrast-induced nephropathy （CIN） in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary interventions （PCI）. Methods From October 1, 2013 to October 1, 2014, 87 STEMI patients undergoing primary PCI in Daxing Hospital of Capital Medical University were consecutively enrolled in this study. All patients were randomly divided into sodium bicarbonate hydration （SB） group and control （NSB） group. The serum creatinine （SCr）, estimated glomerular filtration rate （eGFR）, serum potassium, N-terminal pro brain natriureic peptide （NT-pro BNP） levels and the pH value, the concentration of standard bicarbonate in arterial blood sample were measured on admission and at 24 h, 48 h and 72 h after primary PCI. The incidences of CIN, hypokalemia and metabolic alkalosis were analyzed in each group. Results Forty-three patients were included in SB group while the other forty-four patients were included in NSB group. The average intake volume of 1.4% sodium bicarbonate solution in SB group was （583.2 ± 87.7） ml. There was no significant difference in contrast volume administered during the process of primary PCI between two groups （SB： 237 ± 95 ml vs. NSB： 249 ± 102 ml, P 〉 0.05）. Within 72 h after primary PCI, the incidence of CIN in SB group was significantly lower than that in NSB group （2/43; 4.7% vs 10/44; 22.7%,P 〈 0.05）. While there were no significant differences in the levels of NT-pro BNP （SB： 1 275.3 ±116.9 pg/ml vs NSB： 1 238.9 ±135.4 pg/ml, P 〉 0.05）, the incidences of hypokalemia （SB： 6/43; 14.0% vs NSB： 4/44; 9.1%,P 〉 0.05） and metabolic alkalosis （SB： 5/43; 11.6% vs NSB： 3/44; 6.8%,P 〉 0.05）. Conclusion This study shows that using standard hydration regimen of sodium bicarbonate can effectively reduce the incidence of CIN in STEMI patients undergoing primary PCI without increasing incid

关 键 词：造影剂肾病 ST段抬高型心肌梗死 碳酸氢钠 

分 类 号：R541-4[医药卫生—心血管疾病]