应重视冠脉介入围术期水化预防对比剂急性肾损伤个性化方案  

Attention should be paid to individualization in the prevention of contrast-associated acute kidney injury during prevention hydration of coronary intervention

作　　者：陈竹君[1] 魏水生[1] 杨辉剑[1] 刘勇[1] 彭迳英[1] 丘伟燕[1] 郭照东 应明 CHEN Zhujun;WEI Shuisheng;YANG Huijian;LIU Yong;PENG Jingying;QIU Weiyan;GUO Zhaodong;YIN Ming(Department of Cardiology,Guangdong Provin?cial Key Laboratory of Coronary Heart Disease Prevention,Guangdong Cardiovascular Institute,Guangdong Provin?cial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]广东省冠心病预防重点实验室心内科,广东省心血管研究所,广东省人民医院心内科,广东医学科学院,广州510100

出　　处：《实用医学杂志》2020年第7期849-853,共5页The Journal of Practical Medicine

摘　　要：随着介入技术的全面普及,对比剂使用量也呈迅猛增长趋势,对比剂相关急性肾损伤(CA-AKI)的防治将面临严峻挑战。从病理生理机制上分析,对比剂相关急性肾损伤主要包括以下直接和间接肾损伤及血流动力学障碍。首先,在血管内暴露对比剂会导致短暂的全身血管舒张,导致肾血管床的强烈收缩。肾髓质外血管收缩有较低的基线氧张力,导致氧供需不匹配及肾小管缺血性损伤。第二,对对比剂引起的肾小管上皮细胞有直接毒性作用。再次,对比剂的使用导致活性氧(ROS)的产生,这将加速肾小管细胞损伤。但新近研究表明,未经过精准评估的过量水化策略不但不能有效降低CA-AKI发生率,还会导致严重不良事件发生风险增加。基于以上前景,探索个体化、高效、低成本、易推广的个体化水化治疗方案具有重大临床意义。With the comprehensive popularization of interventional technology,the use of contrast agent is also increasing rapidly,and the prevention and treatment of contrast-associated acute kidney injury(CA-AKI)will face severe challenges. According to the pathophysiological mechanism,adequate hydration can partly improve the decrease of cardiac output and hypotension secondary to acute myocardial infarction in patients with coronary heart disease,so as to improve hemodynamic disorders and increase renal perfusion to protect the kidney. In addition,full hydration can dilute the concentration of contrast agent,accelerate the excretion of contrast agent,reduce the viscosity of renal tubule,improve the ischemia of renal medulla tubule cells,and weaken the direct cytotoxicity of contrast agent. However,recent studies have shown that excessive hydration can not only not effectively reduce the incidence of CA-AKI,but also lead to an increase in the incidence of serious adverse events. Based on the above prospects,it is of great clinical significance to explore a simple,non-invasive,high efficiency,low cost and easy to popularize individualized hydration prevention scheme.

关 键 词：对比剂相关急性肾损伤 水化方案 个体化 

分 类 号：R541.4[医药卫生—心血管疾病]