静脉水化和口服水化预防心功能不全患者对比剂肾病临床应用  

Clinical application of intravenous hydration or oral hydration in preventing contrast-induced nephropathy in patients with cardiac insufficiency

作　　者：丁力[1] 庄国红[1] 丁飚[1] 

机构地区：[1]上海交通大学附属第六人民医院心内科,200233

出　　处：《介入放射学杂志》2016年第1期15-18,共4页Journal of Interventional Radiology

摘　　要：目的探讨静脉和口服两种水化疗法预防心功能不全患者经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的效果。方法连续收集2012年11月至2014年11月在上海交通大学附属第六人民医院接受PCI术治疗的心功能不全患者180例,随机分为静脉水化组(n=90)和口服水化组(n=90),术前及术后6 h内分别经静脉滴注和口服途径补充生理盐水。检测两组患者术前,术后24 h、48 h、72 h血清肌酐(SCr)及脑钠肽(BNP)水平,单因素方差分析比较两组间变化差异。结果静脉水化组和口服水化组间术后24 h、48 h、72 h SCr和BNP水平差异均无统计学意义(P>0.05),两组间心功能不全Ⅲ级患者术后24 h、48 h BNP水平差异有统计学意义(P<0.05)。结论静脉和口服两种水化疗法均可有效地预防心功能不全患者PCI术后CIN,但心功能Ⅲ级患者接受口服水化疗法更加安全、易行。Objective To investigate the clinical effectiveness of intravenous hydration or oral hydration for the prevention of contrast-induced nephropathy （CIN） occurring in patients with cardiac insufficiency after percutaneous coronary intervention （PCI）. Methods A total of 180 consecutive patients with cardiac insufficiency, who were admitted to the Affiliated Sixth People＇s Hospital of Shanghai Jiaotong University during the period from November 2012 to November 2014 to receive PCI, were enrolled in this study. The patients were randomly divided into intravenous hydration group （n=90） and oral hydration group （n=90）. Before PCI and 6 hours after PCI, supplementary saline was respectively given through intravenous dripping or oral intake to the patients of the two groups. Before PCI and 24, 48 and 72 hours after PCI, serum creatinine （SCr） and brain natriuretic peptide （BNP） levels were determined, and the results were compared between the two groups using single factor variance analysis. Results No statistically significant differences in SCr and BNP levels determined at 24, 48 and 72 hours after PCI existed between the intravenous hydration group and oral hydration group （P〉0.05） ; while in patients with grade Ⅲ cardiac insufficiency, the differences in BNP levels determined at 24 and 48 hours after PCI were statistically significant between the intravenous hydration group and oral hydration group （P〈0.05）. Conclusion Both intravenous hydration and oral hydration can effectively prevent the occurrence of contrast-induced nephropathy in patients with cardiac insufficiency after PCI, but oral hydration is more safe and simple for patients with grade Ⅲ cardiac insufficiency.

关 键 词：对比剂肾病 静脉水化 口服水化 心功能不全 经皮冠状动脉介入治疗 

分 类 号：R692[医药卫生—泌尿科学] R54[医药卫生—外科学]