中药联合小剂量呋塞米预防造影剂相关肾病的疗效观察  

Clinical Efficacy of Chinese Medicine Combined with Low-dose Furosemide in the Prevention of Contrast-induced Nephropathy

作　　者：王洪恩 郭宁 张胜高 周瑞红 李恒 WANG Hong-en;GUO Ning;ZHANG Sheng-gao;ZHOU Rui-hong;LI Heng(Suzhou Hospital of Integrated Traditional Chinese and Western Medicine,Suzhou Jiangsu 215101)

机构地区：[1]苏州市中西医结合医院,江苏苏州215101

出　　处：《世界中西医结合杂志》2023年第6期1238-1241,1252,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：江苏省中医药局科技项目(YB2017062)。

摘　　要：目的 探讨中药联合小剂量呋塞米预防造影剂相关肾病的疗效观察。方法 选取2017年5月—2019年12月期间苏州市中西医结合医院收治的138例冠脉造影术患者,按随机数字表法分为常规组、中药组、中西医结合组,每组各46例。冠脉造影术期间,常规组给予水化治疗,中药组给予水化+泄浊解毒法治疗,中西医结合组给予水化+泄浊解毒法+小剂量利尿剂治疗。术后48 h,观察比较3组患者冠脉造影术相关情况、造影剂相关肾病发生率、不良反应发生率、手术前与术后48 h肾功能指标[血清肌酐(Serum creatinine, Scr)、肌酐清除率(Creatinine clearance, Ccr)、肾小球滤过率(Glomerular filtration rate, GFR)]水平变化。结果 3组患者造影剂使用剂量、手术入路方式及冠脉病变情况比较,差异无统计学意义(P>0.05)。术后48 h,常规组及中药组血清Scr水平较手术前升高,Ccr、GFR水平较手术前降低,差异有统计学意义(P<0.05),中西医结合组各项指标与手术前比较,差异无统计学意义(P>0.05);且中药组各项指标均优于常规组,中西医结合组各项指标均优于常规组和中药组,差异有统计学意义(P<0.05)。3组患者造影剂相关肾病发生率比较,中西医结合组低于常规组,差异有统计学意义(P<0.05);中药组与常规组比较,差异无统计学意义(P>0.05)。术后中西医结合组不良事件发生率2.17%(1/46)与中药组13.04%(6/46)、常规组19.57%(9/46)比较,差异有统计学意义(P<0.05);中药组与常规组比较,差异无统计学意义(P>0.05)。结论 在充分水化基础上,泄浊解毒法有利于预防冠脉造影术后造影剂相关肾病,且联合小剂量利尿剂效果更为显著,能够改善患者肾功能,降低心脏不良事件发生率。Objective To explore the efficacy of Chinese medicine combined with low-dose furosemide in the prevention of contrast-induced nephropathy(CIN).Methods A total of 138 patients undergoing coronary angiography at the Suzhou Hospital of Integrated Traditional Chinese and Western Medicine between May 2017 and December 2019 were enrolled and randomly divided into three groups:a conventional group,a Chinese medicine group,and a combination group,with 46 patients in each group.During coronary angiography,the conventional group received rehydration therapy,the Chinese medicine group received rehydration+turbidity-descending and toxin-removing therapy,and the combination group received rehydration+turbidity-descending and toxin-removing therapy+low-dose furosemide.After 48 hours,the coronary angiography-related conditions,incidence of CIN,adverse reactions,and changes in renal function indicators[serum creatinine(Scr),creatinine clearance(Ccr),and glomerular filtration rate(GFR)]before and 48 hours after surgery were observed and compared among the three groups.Results There were no significant differences in the contrast dosage,surgical approach,and coronary artery lesions among the three groups(P>0.05).After 48 hours,the serum Scr levels increased,and Ccr and GFR levels decreased compared with those before surgery in the conventional and Chinese medicine groups(P<0.05).There were no significant differences in these indicators in the combination group compared with those before surgery(P>0.05).Moreover,all indicators in the Chinese medicine group were superior to those in the conventional group,and all indicators in the combination group were superior to those in the conventional and Chinese medicine groups(P<0.05).The incidence of CIN was lower in the combination group than in the conventional group(P<0.05).There was no significant difference in the incidence of CIN between the Chinese medicine group and the conventional group(P>0.05).The incidence of adverse events after surgery was 2.17%(1/46)in the combina

关 键 词：冠脉造影术 造影剂相关肾病 泄浊解毒法 小剂量利尿剂 肾功能 

分 类 号：R692[医药卫生—泌尿科学]