我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

老年慢性肾功能不全患者冠状动脉介入治疗中连续性静静脉血液滤过预防对比剂肾病的效果

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2016年第2期
页码:
179-181
栏目:
临床研究
出版日期:
2015-11-25

文章信息/Info

Title:
Effect of continuous venovenous hemofiltration on prevention of contrast-induced nephropathy during percutaneous coronary intervention in elderly patients with chronic kidney disease
作者:
熊日成; 俞 宙; 郭振辉; 孙 杰
(广州军区广州总医院老年重症医学科、广东省暨广州市老年感染与器官功能支持重点实验室，广东 广州 510010)
Author(s):
XIONG Ri-cheng;  YU Zhou;  GUO Zhen-hui;  SUN Jie
(Department of Medical Intensive Care Unit, Guangzhou General Hospital, Guangzhou Military Area Command, & Guangdong Provincial and Guangzhou Municipal Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou 510010, Guangdong, China)
关键词:
老年人; 肾功能不全; 慢性; 冠状动脉介入治疗; 连续性静静脉血液过滤; 对比剂肾病
Keywords:
older patients;  chronic kidney disease;  percutaneous coronary intervention;  continuous venovenous hemodialysis;  contrast-induced nephropathy
分类号:
R541.4；R692.5
DOI:
-
文献标识码:
A
摘要:
目的 观察和分析连续性静静脉血液过滤(continuous venovenous hemofiltration,CVVH)对老年肾功能不全患者行冠状动脉介入（PCI）治疗期间发生对比剂肾病（CIN）的预防效果。方法 回顾性分析我院60例肾功能不全行PCI的老年患者，按治疗肾功能不全的方法分为CVVH组（30例）与常规水化组（30例）。CVVH组术前4 h及术后18 h给予CVVH，常规水化组术前12 h及术后12 h给予生理盐水。检测两组患者术前和术后即刻、24 h、72 h和1 周的血肌酐，比较两组术后CIN的发生率。并随防6个月，观察和分析进入持续血透、非死亡心血管事件和死亡发生率。结果 两组患者临床特点无显著差异，PCI手术情况无显著差异。两组术后即刻、24 h、72 h和1周血肌酐比较有显著差异（P<0.05，P<0.01）。CVVH组CIN发生率7%，常规水化组30%，两组相比差异显著（P<0.05）。随访（5.6±1.2）个月，CVVH组需维持血透1例、常规水化组7例，CVVH组新发心血管事件1例，常规水化组6例，均有显著差异(P<0.05)。两组分别死亡1例和2例，病死率无显著差异。结论 对于老年肾功能不全的冠心病患者，PCI前后行CVVH可以显著减少CIN、维持血透及心血管事件的发生率。
Abstract:
AIM To assess the value of continuous venovenous hemofiltration (CVVH) in the prevention of contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in elderly patients with chronic kidney disease (CKD). METHODS We evaluated 60 CKD elderly patients undergoing PCI. The 60 elderly patients were divided into hemofiltration group (n=30) and hydration group (n=30) according to hemofiltration. In the hemofiltration group, hemofiltration was initiated 4 h before PCI and re-started immediately post-PCI for 18 h. In the hydration group, 0.9% NaCl 100 ml/h was given, respectively, for 12 h pre- and post-procedure. We measured serum creatinine levels before PCI and at 0 h, 24 h, 72 h and 1 week after PCI. We observed the incidence of CIN and the short-term clinical efficacy of hemofiltration. Long-term hemodialysis, non-fatal major cardiovascular events and death rates were compared between groups after the 6-month follow-up. RESULTS There was no significant difference in clinical characteristics (age, gender, mean arterial pressure, diabetes, hypertension, hyperlipidemia, creatinine, heart failure) between groups. There was a significant difference in serum creatinine levels (0 h, 24 h, 72 h and 1 week after PCI) between groups (P<0.05, P<0.01). Incidence of CIN was 7% in the hemofiltration group and 30% in the hydration group, with significant difference between groups (P<0.05). The 6-month follow-up ［mean (5.6±1.2) m］ found significant differences between groups in the cases dependent on long-term hemodialysis (one in the hemofiltration group and seven in the hydration group, P<0.05) and in non-fatal cardiovascular events (one in the hemofiltration group and six in the hydration group, P<0.05). There was no significant difference between groups in the death rate (one in the hemofiltration group and two in the hydration group). CONCLUSION For patients with renal insufficiency, hemofiltration during PCI may reduce the incidence of CIN and non-fatal cardiovascular events.

参考文献/References

[1]Spini V,Cecchi E,Chiostri M,et al.Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures[J].J Invasive Cardiol,2013,25(2):80-84.
[2]陈韵岱,陈纪言,傅国胜,等.碘对比剂血管造影应用相关不良反应中国专家共识[J].中国介入心脏病学杂志,2014,22(6):341-348.
[3]Deray G.Dialysis and iodinated contrast media[J].Kidney Int Suppl,2006,(100):S25-S29.
[4]Andrencci M,Faga T,Pisani A,et al.The choice of the iodinated radiographic contrast media to prevent contrast-induced nephropathy[J].Advances in Nephrology,2014,2014:691623.
[5]王 昆,徐同标,王 涟,等.严重肾功能不全患者冠状动脉介入治疗后行CVVH预防对比剂肾病的发生[J].中国介入心脏病学杂志,2014,22(9):578-581.
[6]豆亚静，陈 晖，严松彪.对比剂肾病的研究进展[J].中华临床医师杂志(电子版),2012,6(7):1816-1818.
[7]Andreucci M,Faga T,Pisani A,et al.Prevention of contrast-induced nephropathy through a knowledge of its pathogenesis and risk factors[J].Scientific World Journal,2014,2014:823169.

备注/Memo

备注/Memo:
收稿日期：2015-03-26.
作者简介：熊日成，副主任医师，硕士 Email:xricheng@163.com
更新日期/Last Update: 2016-04-25