不同温度非离子型造影剂对冠脉介入术中不良反应及术后肾功能和凝血功能的影响  

Effect of nonionic contrast agents at different temperatures on adverse reactions during coronary intervention and postoperative renal function and coagulation function

作　　者：贺大春[1] 舒成 姜金爱 张兴红[1] 姜志华[1] 王春丽 段咏莲 田芙蓉 龙远玲 钱德富[1] He Dachun;Shu Cheng(Hubei Aerospace Hospital,Xiaogan 432000)

机构地区：[1]湖北航天医院

出　　处：《中国现代医药杂志》2019年第10期6-10,共5页Modern Medicine Journal of China

基　　金：中国航天科工集团公司医疗卫生科研项目(编号：2017-LCYL-012)

摘　　要：目的观察不同温度非离子型造影剂对冠脉介入术中不良反应及术后肾功能和凝血功能的影响。方法选取我院2017年9月~2019年1月冠脉介入患者270例,按造影剂温度设20℃、28℃、37℃三组,每组随机入组90例患者,观察冠脉介入前后血肌酐(Scr)、尿素氮(BUN)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准比值(INR)的变化,术中总不良反应发生率、心电监护ST-T一过性改变、血管痉挛、胸闷胸痛等自我不适感频次。结果各组间术前和术后Scr及BUN水平均无统计学差异(P>0.05),组内术前术后Scr差异无统计学意义(P>0.05),BUN差异有统计学意义(P<0.05)。总不良反应发生率组间比较有统计学差异(P<0.05),ST-T一过性变化发生率有统计学差异(P<0.05),温度越高,ST-T改变、总不良反应发生率越低;组间比较,温度越高,血管痉挛及不适症状发生率越低,但差异无统计学意义(P>0.05)。术前术后凝血功能组间比较无统计学差异(P>0.05),20℃组术前术后INR水平差异有统计学意义(P<0.05),28℃组术前术后PT、APTT水平差异有统计学意义(P<0.05),37℃组术前术后PT、INR、APTT水平差异有统计学意义(P<0.05)。结论提高造影剂的温度至37℃,可明显降低术中不良反应发生率,造影剂温度对肾功能的改变没有影响,控制造影剂使用量和水化是预防造影剂肾病的良好方法,使用37℃造影剂患者凝血功能指标明显延长,原因及是否具有临床意义还需进一步研究。Objective To observe the effect of nonionic contrast agents at different temperatures on adverse reactions during coronary intervention and postoperative renal function and coagulation function. Methods Selected 270 cases with coronary intervention from Sep 2017 to Jan 2019 in our hospital, according to the contrast agent temperature set 20℃, 28℃, 37℃ three groups, each group was randomly enrolled 90 patients. Observed the changes of serum creatinine (Scr), urea nitrogen (BUN), prothrombin time (PT), activated partial live clotting enzyme (APTT), and the international standard ratio(INR) before and after coronary intervention, the incidence of total adverse reactions during the operation, the transient change of ECG monitoring ST-T, the frequency of vascular spasm, chest tightness, chest pain and self-discomfort. Results There was no significant difference in Scr and BUN levels between the groups before and after surgery (P> 0.05). There was no significant difference in preoperative and postoperative Scr in each group (P> 0.05), there was significant difference in BUN (P< 0.05). The incidence of total adverse reactions and the transient change of ST-T were significantly different between the groups (P< 0.05), the higher the temperature, the lower the incidence of ST-T change and the total adverse reactions. The higher the temperature, the lower the incidence of vasospasm and discomfort, but there was no significant difference among the groups (P> 0.05). There was no significant difference in preoperative and postoperative coagulation function between the groups (P> 0.05). There was significant difference in preoperative and postoperative INR levels in 20℃ group (P< 0.05), PT and APTT levels in 28℃ group (P< 0.05), PT, INR and APTT levels in 37℃ group (P< 0.05). Conclusion Increasing the temperature of contrast agent to 37℃ can significantly reduce the incidence of intraoperative adverse reactions. Contrast agent temperature has no effect on renal function. Controlling the amount of contrast agent an

关 键 词：造影剂 不良反应 造影剂肾病 凝血功能 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]