老年慢性肾功能不全患者冠状动脉介入治疗中连续性静静脉血液滤过预防对比剂肾病的效果  

Effect of continuous venovenous hemofiltration on prevention of contrastinduced nephropathy during percutaneous coronary intervention in elderly patients with chronic kidney disease

作　　者：熊日成[1] 俞宙[1] 郭振辉[1] 孙杰[1] 

机构地区：[1]广州军区广州总医院老年重症医学科、广东省暨广州市老年感染与器官功能支持重点实验室,广东广州510010

出　　处：《心脏杂志》2016年第2期179-181,共3页Chinese Heart Journal

摘　　要：目的观察和分析连续性静静脉血液过滤(continuous venovenous hemofiltration,CVVH)对老年肾功能不全患者行冠状动脉介入(PCI)治疗期间发生对比剂肾病(CIN)的预防效果。方法回顾性分析我院60例肾功能不全行PCI的老年患者,按治疗肾功能不全的方法分为CVVH组(30例)与常规水化组(30例)。CVVH组术前4 h及术后18 h给予CVVH,常规水化组术前12 h及术后12 h给予生理盐水。检测两组患者术前和术后即刻、24 h、72 h和1周的血肌酐,比较两组术后CIN的发生率。并随防6个月,观察和分析进入持续血透、非死亡心血管事件和死亡发生率。结果两组患者临床特点无显著差异,PCI手术情况无显著差异。两组术后即刻、24 h、72 h和1周血肌酐比较有显著差异(P<0.05,P<0.01)。CVVH组CIN发生率7%,常规水化组30%,两组相比差异显著(P<0.05)。随访(5.6±1.2)个月,CVVH组需维持血透1例、常规水化组7例,CVVH组新发心血管事件1例,常规水化组6例,均有显著差异(P<0.05)。两组分别死亡1例和2例,病死率无显著差异。结论对于老年肾功能不全的冠心病患者,PCI前后行CVVH可以显著减少CIN、维持血透及心血管事件的发生率。AIM To assess the value of continuous venovenous hemofihration （CVVH） in the prevention of contrast-induced nephropathy （CIN） during pereutaneous coronary intervention （PCI） in elderly patients with chronic kidney disease （CKD）. METHODS We evaluated 60 CKD elderly patients undergoing PCI. The 60 elderly patients were divided into hemofihration group （ n = 30） and hydration group （n = 30） according to hemofihration. In the hemofiltration group, hemofihration was initiated 4 h before PCI and re-started immediately post-PCI for 18 h. In the hydration group, 0. 9% NaC1 100 ml/h was given, respectively, for 12 h pre- and post-procedure. We measured serum creatinine levels before PCI and at 0 h, 24 h, 72 h and 1 week after PCI. We observed the incidence of CIN and the short-term clinical efficacy of hemofihration. Long-term hemodialysis, non-fatal major cardiovascular events and death rates were compared between groups after the 6-month follow-up. RESULTS There was no signif- icant difference in clinical characteristics （age, gender, mean arterial pressure, diabetes, hypertension, hyperlipidemia, creatinine, heart failure） between groups. There was a significant difference in serum creatinine levels （0 h, 24 h, 72 h and 1 week after PCI） between groups （ P 〈 0. 05, P 〈 0. 01 ）. Incidence of CIN was 7% in the hemofiltration group and 30% in the hydration group, with significant difference between groups （P 〈 0. 05 ）. The 6-month foUow-up [ mean （5.6 -＋ 1.2 ） m ~ found significant differences between groups in the cases dependent on long-term hemodialysis （one in the hemofiltration group and seven in the hydration group, P 〈 0. 05） and in non-fatal cardiovascular events （one in the hemofiltration group and six in the hydration group, P 〈 0. 05）. There was no significant difference between groups in the death rate （one in the hemofiltration group and two in the hydration group）. CONCLUSION For patients with renal insufficiency, hemofihration during PCI ma

关 键 词：老年人 肾功能不全 慢性 冠状动脉介入治疗 连续性静静脉血液过滤 对比剂肾病 

分 类 号：R541.4[医药卫生—心血管疾病] R692.5[医药卫生—内科学]