经皮冠状动脉腔内成形术后应用降压药对肾功能的影响  

Effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty

作　　者：姜慧妍 严思敏 葛卫红[1] JIANG Huiyan;YAN Simin;GE Weihong(Department of Pharmacy,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院药学部,南京210008

出　　处：《药学实践杂志》2022年第1期89-92,共4页Journal of Pharmaceutical Practice

摘　　要：目的评估经皮冠状动脉腔内成形术后应用抗高血压药对患者肾功能损伤的影响。方法回顾分析2020年1月至2020年12月在南京鼓楼医院心血管内科行经皮冠状动脉腔内成形术治疗并且规律服用抗高血压药物的患者,共193例。根据用药种类不同分为4组:血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)组、β受体阻滞剂组、钙离子通道阻滞剂(CCB)组、单纯水化组,所有患者围术期均给予常规水化。比较患者手术前后肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(eGFR)、肌酐清除率(Ccr)的水平变化。结果4组患者造影剂术后造影剂肾病的发生率为0。与术前相比,4组患者在Scr与Ccr水平上无明显变化,除单纯水化组,其余3组在术后BUN水平降低,其中,β受体阻滞剂组显著降低,且与单纯水化组、CCB组存在统计学差异。此外,β受体阻滞剂组术后eGFR水平也显著降低,其中,血压高值的患者(SBP≥140或DBP≥90)在术前Scr与Ccr水平即与正常血压者(SBP<140且DBP<90)存在差异。结论冠状动脉造影术前使用ACEI/ARB与CCB类抗高血压药对患者短期内肾功能无影响,β受体阻滞剂可能轻微降低肾功能,应对高血压人群特别关注。Objective To evaluate the effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty.Methods A retrospective analysis was performed on 193 patients who underwent percutaneous transluminal coronary angioplasty and took antihypertensive drugs regularly.Those patients were admitted to Nanjing Drum Tower Hospital during January 2020 to December 2020.The patients were divided into ACEI/ARB group,β-blockers,calcium channel blockers and hydration control group.All patients received routine hydration during the perioperative period.The changes of serum creatinine(Scr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)and endogenous creatinine clearance rate(Ccr)before and after operation were compared.Results The incidence of CIN was 0%in four groups.Compared with the preoperative,there was no significant change in Scr and Ccr in every group.Except for the hydration control group,the BUN levels in three treated groups were reduced after postoperative.Specifically,the BUN reduction inβ-blockers group has statistically significant difference compared to the hydration control group and CCB group.In addition,eGFR levels were significantly reduced in theβ-blockers group.Preoperative Scr and Ccr levels in patients with high blood pressure(SBP≥140 or DBP≥90)were significantly different from the patients with normal blood pressure(SBP<140 and DBP<90).Conclusion The use of ACEI/ARB and CCB before percutaneous transluminal coronary angioplasty had no effect on renal function in the short term.β-blockers can slightly reduce renal function,especially in patients with high blood pressure,who should receive special attention.

关 键 词：经皮冠状动脉腔内成形术 造影剂肾病 血管紧张素转化酶抑制剂 血管紧张素受体拮抗剂 β受体阻滞剂 钙离子通道阻滞剂 

分 类 号：R969.3[医药卫生—药理学]