对比剂对行PCI术STEMI患者发生CIN及预后的影响  

Effect of contrast agent on CIN and prognosis in patients with STEMI undergoing PCI

作　　者：尹晓翔[1] 杜森 鲍志国[1] 张进 刘梦雯 赵森[1] YIN Xiaoxiang;DU Sen;BAO Zhiguo;ZHANG Jin;LIU Mengwen;ZHAO Sen(Image center of the First Affiliated Hospital of Henan University,Kaifeng 475000,P.R.China)

机构地区：[1]河南大学第一附属医院影像中心,河南开封475000

出　　处：《医学影像学杂志》2020年第9期1611-1615,共5页Journal of Medical Imaging

基　　金：河南省卫计委医学科技攻关计划联合共建项目(编号:2018020313)。

摘　　要：目的探讨对比剂对行经皮冠状动脉介入治疗(PCI)术对ST段抬高型心肌梗死(STEMI)患者发生对比剂肾病(CIN)及预后的影响。方法选取在2015年8月~2018年8月期间我院收治的SIEMI患者80例进行观察。采用随机数字表法,随机将患者分成观察组和对照组,每组均为40例。其中对照组采取低渗对比剂行PCI术,观察组则实施等渗对比剂行PCI术。之后比较两组患者不同时间点血清肌酐的水平、CIN的发生情况、CIN的影响因素及预后情况。结果观察组患者在术后24h、术后48h及术后72h的血清肌酐水平显著低于对照组(P<0.05)。观察组术后CIN发生率(7.50%)显著低于对照组(25%)(χ^2=4.501,P<0.05)。发生CIN组慢性肾功能不全患者比例及对比剂使用量上显著高于未发生CIN组,但是在入院血红蛋白水平上却显著低于未发生CIN组(P<0.05)。入院血红蛋白、慢性肾功能不全及对比剂使用剂量是PCI术后发生CIN的独立影响因素。在PCI术后30天,两组患者在终点事件的总发生率差异无统计学意义(P>0.05)。结论相比于低渗对比剂,等渗对比剂有利于降低行PCI对STEMI患者CIN的发生率且肾功能安全更高;入院血红蛋白、慢性肾功能不全及对比剂使用剂量是PCI术后发生CIN的独立影响因素。Objective To investigate the effect of contrast media on the incidence of contrast nephropathy(CIN)and prognosis in patients with ST segment elevation myocardial infarction(STEMI).Methods 80 SIEMI patients admitted in our hospital from August 2015 to August 2018 were selected for observation.The patients were randomly divided into an observation group and a control group using a random number table method,and each group had 40 patients.The control group underwent PCI with hypotonic contrast,and the observation group underwent PCI with isotonic contrast.Then,the serum creatinine level,the occurrence of CIN,the factors affecting CIN and the prognosis of the two groups were compared at different time points.Results The serum creatinine levels in the observation group at 24 hours,48 hours,and 72 hours after surgery were significantly lower than those in the control group(P<0.05).The incidence of postoperative CIN in the observation group(7.50%)was significantly lower than that in the control group(25%)(χ^2=4.501,P<0.05).The proportion of patients with chronic renal insufficiency in the CIN group and the amount of contrast agent used were significantly higher than those in the group without CIN,but the admission hemoglobin level was significantly lower than that in the group without CIN(P<0.05).Admission of hemoglobin,chronic renal insufficiency,and the use of contrast agents were independent factors that affected CIN after PCI.At 30 days after PCI,there was no significant difference in the total incidence of endpoint events between the two groups(P>0.05).Conclusion Compared with hypotonic contrast agent,isotonic contrast agent is beneficial for reducing the incidence of CIN and higher renal function safety in patients with STEMI undergoing PCI;admission of hemoglobin,chronic renal insufficiency and the use of contrast agent after PCI are CIN independent factors.

关 键 词：经皮冠状动脉介入治疗 心肌梗死 对比剂肾病 介入性放射学 

分 类 号：R543.3[医药卫生—心血管疾病] R815[医药卫生—内科学]