不同方案对老年冠心病并轻度肾功能不全患者择期经皮冠状动脉介入治疗后对比剂肾病的预防效果及其影响因素研究  

Prevention Effect of Different Plan on Contrast-induced Nephropathy in Elderly Patients with Coronary Heart Disease Complicated with Mild Renal Insufficiency after Selective Percutaneous Coronary Intervention and Its Influencing Factors

作　　者：陈璐[1] 王用 邢玉龙 刘华英 赵先静 诸雯 CHEN Lu;WANG Yong;XING Yulong;LIU Huaying;ZHAO Xianjing;ZHU Wen(Department of Cardiovascular Medicine,Gaochun Branch,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 211300,China)

机构地区：[1]南京大学医学部附属鼓楼医院高淳分院心血管内科,江苏省南京市211300

出　　处：《实用心脑肺血管病杂志》2021年第7期110-114,120,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：南京市卫生科技发展专项资金项目(YKK18196);南京市医学科技发展资金(QRX17212)。

摘　　要：背景老年冠心病患者是对比剂肾病(CIN)的高危人群,其中合并轻度肾功能不全者术后CIN发生率高达30%以上。有研究显示,静脉水化对老年轻度肾功能不全患者术后CIN的预防效果较佳,但关于口服水化对肾功能不全患者术后CIN预防效果的文献报道较少。目的探讨不同方案对老年冠心病并轻度肾功能不全患者择期经皮冠状动脉介入治疗(PCI)后CIN的预防效果及其影响因素,以期为临床医生及早、准确地诊断和预防CIN提供参考依据。方法本研究为前瞻性研究。选取2018年10月—2020年5月南京大学医学部附属鼓楼医院高淳分院收治的行择期PCI的老年冠心病并轻度肾功能不全患者90例,根据水化方式分为口服水化组和静脉水化组,各45例。口服水化组患者采用口服水化方式,静脉水化组患者采用静脉水化方式。收集患者的临床资料,采用多因素Logistic回归分析探讨老年冠心病并轻度肾功能不全患者择期PCI后并发CIN的影响因素。结果口服水化组患者消化道不适发生率低于静脉水化组(P<0.05)。根据患者择期PCI后是否发生CIN将其分为CIN组21例和非CIN组69例。CIN组患者体质指数(BMI)、糖尿病发生率及低密度脂蛋白胆固醇(LDL-C)、胱抑素C水平高于非CIN组,手术时间长于非CIN组,对比剂用量大于非CIN组,β2-微球蛋白水平低于非CIN组(P<0.05)。多因素Logistic回归分析结果显示,糖尿病[OR=1.632,95%CI(1.038,2.564)]、对比剂用量[OR=1.036,95%CI(1.009,1.063)]、胱抑素C水平[OR=5.454,95%CI(1.500,19.819)]是老年冠心病并轻度肾功能不全患者择期PCI后并发CIN的独立影响因素(P<0.05)。结论口服水化与静脉水化对老年冠心病并轻度肾功能不全患者择期PCI后CIN的预防效果相当,但静脉水化可更有效地减少患者消化道不适症状,而糖尿病、对比剂用量、胱抑素C水平是老年冠心病并轻度肾功能不全患者择期PCI后并发CIN的独立影�Background Elderly patients with coronary heart disease are high-risk group of contrast medium nephropathy(CIN),the incidence of CIN of patients with mild renal insufficiency can be as high as 30%.Studies have proved that intravenous hydration have better prevention effect for elderly patients with mild renal insufficiency.However,there are few literature reports on the preventive effect of oral hydration on CIN of patients with renal insufficiency.Objective To discuss the prevention plan and influencing factors of CIN in elderly patients with coronary heart disease complicated with mild renal insufficiency after selective percutaneous coronary intervention(PCI),so as to provide reference for clinicians to diagnose and prevent CIN early and accurately.Methods This study is a prospective study.A total of 90 elderly patients with coronary heart disease complicated with mild renal insufficiency who underwent selective PCI in Gaochun Branch,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from October 2018 to May 2020 were selected and divided into the oral hydration group and the intravenous hydration group,45 cases in each group.Patients in the oral hydration group were treated with oral hydration,patients in the intravenous hydration group were treated with intravenous hydration.Clinical data of patients were collected,and multivariate Logistic regression analysis was used to explore the influencing factors of CIN in elderly patients with coronary heart disease complicated with mild renal insufficiency after selective PCI.Results The incidence of gastrointestinal discomfort in the oral hydration group was lower than that in the intravenous hydration group(P<0.05).Patients were divided into CIN group(n=21)and non-CIN group(n=69)according to whether they occurred CIN after selective PCI.Body mass index(BMI),incidence of diabetes and levels of low density lipoprotein cholesterol(LDL-C)and cystatin C in the CIN group were higher than those of the non-CIN group,operation time was

关 键 词：冠心病 肾病 肾功能不全 对比剂肾病 经皮冠状动脉介入治疗 口服水化 静脉水化 影响因素分析 

分 类 号：R543.3[医药卫生—心血管疾病] R692[医药卫生—内科学]