龙锋,向定成,肖华,张金霞,李慧娣,李爱敏

• 1:上海第二军医大学广州临床医学院
• 2:广州军区广州总医院心血管内科
• 3:珠江医院心血管内科

摘要(Abstract)：

目的通过分析急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)患者围术期至术后1个月肌酸酐值的变化,探讨不同变化类型的特征及意义。方法本研究为回顾性研究,连续入选2015年7月至2016年11月广州军区广州总医院行急诊PCI的STEMI患者,根据肌酸酐值变化规律分为:下降型、递增型、稳定型、U型、倒U型。分析各分型基本特征与Mehran评分的关系、入院至术后1个月时肌酸酐值变化情况及术后1个月内主要不良心肾事件(MARCE)发生率。结果共入选293例患者,急诊PCI术后血清肌酸酐值变化类型占比分别为:下降型组9.9%、递增型组17.7%、稳定型组47.1%、U型组4.1%、倒U型组21.2%。其中递增型组、稳定型组和倒U型组的MARCE发生率稍高于下降型组和U型组。下降型组和U型组中术前低血压状态、扩容治疗比例高于递增型组和倒U型组;倒U型组利尿剂使用比例高于下降型组。术后1个月共有21例(9.1%)肌酸酐值较入院时下降>12.5%,其中有6例(2.6%)下降>25%;有108例(47.0%)肌酸酐值较入院时升高>12.5%,其中有57例(24.8%)升高>25%。下降型组中有10.5%的患者1个月后血肌酸酐值下降>25%,而在递增型组中有50%患者肌酸酐值升高>25%,倒U型组中有35.8%患者肌酸酐值升高>25%。结论急诊PCI术STEMI患者的肌酸酐值存在多种变化趋势,术前低血压状态、利尿剂、扩容治疗是主要的影响因素,部分患者入院初始肌酸酐值可能不宜作为基线肌酸酐值用于对比剂致急性肾损伤的评估。

关键词(KeyWords)： 对比剂致急性肾损伤;急性心肌梗死;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划专项(2016YPC1301201);; 广东省信息产业发展专项基金(粤经信[2014]975号);; 广州市科技计划项目(2014Y2-00068);广州市科技计划项目(201508020043)

作者(Author): 龙锋,向定成,肖华,张金霞,李慧娣,李爱敏

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