王昆,徐标,王涟,宋杰,黄为,高玲,张静梅

• 1:南京大学医学院附属鼓楼医院心脏科

摘要(Abstract)：

目的评估严重肾功能不全患者冠状动脉介入治疗后行床旁血液滤过对对比剂肾病(CIN)的发生率及临床疗效的影响。方法回顾性分析本中心30例因严重肾功能不全行冠状动脉介入治疗的患者,术后即刻给予床旁血液滤过,收集临床资料,检测患者术前和术后24 h、72 h、1周的肌酸酐(肌酐)值,并根据Cockcroft和Gault equation公式计算肌酐清除率(CrCl),评估术后CIN发生率,以及短期临床疗效。结果 30例患者平均年龄(729±8.7)岁,其中男21例(70.0%)。慢性肾疾病分期(CKD)3期3例(10.0%),CKD 4期20例(66.7%),CKD 5期7例(23.3%);平均血液滤过持续时间(7.5±4.1)h,术前和术后24 h、72 h、1周血肌酐值分别为(498.7±143.7)、(353.2±128.0)、(450.0±132.2)、(488.0±145.7)μmol/L,CrCl值分别为(20.3±10.2)、(36.5±14.3)、(28.3±10.4)、(21.0±10.3)ml/min,患者术后未出现CIN。平均随访(3.1±2.6)个月,30例患者未见新发心血管事件,且未见新发需依赖血液透析患者。结论对于严重肾功能不全的患者,介入治疗后行床旁血液滤过可以减少对比剂肾病的发生,是一个可供选择的减少对比剂肾病的预防措施。

关键词(KeyWords)： 严重肾功能不全;冠状动脉介入;血液滤过;对比剂肾病

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王昆,徐标,王涟,宋杰,黄为,高玲,张静梅

参考文献(References)：

• [1]Cockcroft DW,Gault MH.Prediction of creatinine clearance from serum creatinine.Nephron,1976,16:31-41.
• [2]National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:Evaluation,classifi cation and stratifi cation.Am J Kidney Dis,2002,39(Suppl 1):S1-S266.
• [3]Mehran R,Nikolsky E.Contrast-induced nephropathy:dLVEFinition,epidemiology,and patients at risk.Kidney Int Suppl,2006,100:S11-S15.
• [4]Nash K,Hafeez A,Hou S.Hospital-acquired renal insuffi ciency.Am J Kidney Dis,2002,39:930-966.
• [5]Hou SH,Bushinsky DA,Wish JB,et al.Hospital-acquired renal insuffi ciency:a prospective study.Am J Med,1983,74:243-248.
• [6]Jungers P,Massy ZA,Nguyen Khoa T,et al.Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients:a prospective study.Nephrol Dial Transplant,1997,12:2597-2602.
• [7]Briguori C,Airoldi F,D’Andrea D,et al.Renal insufficiency following contrast media administration trial(REMEDIAL):A randomized comparison of 3 preventive strategies.Circulation,2007,115:1211-1217.
• [8]Mueller C,Buerkle G,Buettner HJ,et al.Prevention of contrast media-associated nephropathy:Randomized comparison of2 hydration regimens in 1620 patients undergoing coronary angioplasty.Arch Intern Med,2002,162:329-336.
• [9]Briguori C,Colombo A,Violante A,et al.Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity.Eur Heart J,2004,25:206-211.
• [10]McCullough PA,Wolyn R,Rocher LL,et al.Acute renal failure after coronary intervention:incidence,risk factors,and relationship to mortality.Am J Med,1997,103:368-375.
• [11]刘远辉,谭宁,叶飘,等.肌酐相对正常患者行经皮冠状动脉介入治疗介入术后发生对比剂肾病的危险因素分析.中国介入心脏病学杂志,2013,21:29-33.
• [12]Lorusso V,Taroni P,Alvino S,et al.Pharmacokinetics and safety of iomeprol in healthy volunteers and in patients with renal impairment or end stage renal disease requiring hemodialysis.Invest Radiol,2001,36:309-316.
• [13]Deray G.Dialysis and iodinated contrastmedia.Kidney Int Suppl,2006,100:S25-S29.
• [14]Ghani A,Hussain N,Al Helal B.Can Continuous Venovenous Hemofiltration Prevent Contrast-Agent Induced Nephropathy in patients with Advanced Chronic Kidney Disease after Coronary Angiography.Saudi J Kidney Dis Transpl,2011,22:54-60.
• [15]Cruz DN,Perazella MA,Bellomo R,et al.Extracorporeal blood purification therapies for prevention of radiocontrast-induced nephropathy:a systematic review.Am J Kidney Dis,2006,48:361-371.
• [16]Hung YM,Lin SL,Hung SY,et al.Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography.World J Cardiol,2012,4:157-172.