经皮冠状动脉介入治疗并发对比剂肾病的临床回顾分析

经皮冠状动脉介入治疗并发对比剂肾病的临床回顾分析全军心血管病研究所沈阳军区总医院心内科赵昕韩雅玲王效增王守力荆全民上海2009.09.27•在给对比剂后48小时内，血清肌酐会升高，并在5天内达峰值•若肌酐数值在给对比剂后48小时内比基线值升高大于25%或升高大于0.5mg/dl•研究发现，给予造影剂后，约60%病人肌酐水平在24小时内升高，90%在72小时内升高；造影后的4－5天达峰值，10天后回归正常水平•Marenzi等人发现在CIN病人中，血清肌酐峰值是在术后第2天发生的•Harjai等人建议，术后1.6—1.9天为随访肾功能的最佳时间•延迟肾病造影剂肾病的定义相关国际学会和临床指南中均已涉及对比剂的合理应用与对比剂肾病的预防策略ACC/SCA&I2001ClinicalExpertConsensusDocumentonCardiacCatheterizationLaboratoryStandardsACC/AHA/SCA&I2005GuidelineUpdateforPercutaneousCoronaryInterventionACC/AHA2005GuidelinesfortheManagementofPatientswithPeripheralArterialDiseaseACR2002ACRPracticeGuidelinefortheUseofIntravascularContrastMedia2003PracticeGuidelineforthePerformanceofDiagnosticArteriographyinAdultsESUR2005GuidelinesonContrastMediaFrenchSocietyofRadiology2004Préventiondel’insuffisancerénaleinduiteparlesproduitsdecontrasteiodés2005ProduitsdecontrasteiodésetdiabèteGermanCardiacSociety2005ArbeitsanweisungimHKLNKF2005K/DOQIClinicalPracticeGuidelinesforCardiovascularDiseaseinDialysisPatientsJAMA.2006;295(23):2765-2779.RiskFactorsforContrast-InducedNephropathyPatientRelatedChronickidneydiseaseDiabetesmellitusUrgent/electiveprocedureIntra-aorticballoonpumpCongestiveheartfailureAgeHypertensionLowhematocritHypotensionNotPatientRelatedContrastpropertiesHighosmolarcontrastIoniccontrastContrastviscosityContrastvolume造影剂肾病的危险因子沈阳军区总医院临床资料回顾•ToevaluationtheimpactofcontrastmediaonrenalfunctioninpatientswithcoronaryarteryangiographyorPCIandinvestigatetheriskfactorsofCINandtheeffectsofCINonclinicalprognosisinpatientsduringPCI入选标准Oct1998toDec200810305patientswithPCIorcoronaryarteryangiographyofcompletefollow-updatawereadmitted27to92years（65±12years）Tobeusedtheiso-osmia（iodixanol）orthelow-osmia（iopromide）nonioniccontrastmedium研究方法Serumcreatinineconcentration（SCr）wasmeasuredatbaselineandonthelst，2ndand3rddaysAllSCranalyseswereperformedatShenyangGeneralHospitalToobservemajoradversecardiacevents（MACE）duringhospitalizationToanalyzedtheincidenceoftheriskfactorsofCINretrospectively研究结果0.000.200.400.600.801.00renaldysfunctionhypertensionDMnon-CINgroupCINgroupP=0.001P=0.011P=0.022Morbidity平均应用对比剂剂量348.0231.00100200300400CINgroupnon-CINgroupmlP=0.0001研究结果PCI术前与术后血压124.0135.0119.0130.05080110140170beforePCIafterPCImmHg研究结果non-CINCINP=0.003P=0.019CIN的发生率10.621.6010203040iodixanoliopromideP0.0001研究结果平均住院天数10.04.0048121620CINnon-CINP=0.0001研究结果住院期间MACE发生率及病死率4.2%1.8%6.0%3.2%0.0%2.0%4.0%6.0%8.0%10.0%MACEFtality研究结果non-CINCINP=0.002P=0.0011年无事件生存率81.4%84.4%0.0%20.0%40.0%60.0%80.0%100.0%non-CINCINP=0.010研究结果结论冠心病PCI患者存在多种对比剂肾病的危险因素CIN增加PCI患者住院期间主要不良心脏事件及病死率对高危患者需要进行有效的预防措施等渗非离子对比剂对肾功能的影响较小谢谢