临床肾脏病杂志
臨床腎髒病雜誌
림상신장병잡지
Journal of Clinical Nephrology
2015年
9期
540-544
,共5页
碳酸氢钠%水化%对比剂肾病
碳痠氫鈉%水化%對比劑腎病
탄산경납%수화%대비제신병
Sodium hydrogen carbonate%Hydration%Contrast-induced nephropathy
目的：探讨碳酸氢钠水化方案对冠状动脉造影术后对比剂肾病(contrast-induced ne-phropathy,CIN)的预防作用。方法选取2013年7月至2015年7月在我院心血管内科行冠脉造影术的患者245例为研究对象,随机分为观察组123例以及对照组122例。观察组患者造影术前1 h按3 ml·kg-1·h-1速度静脉输注1.25%碳酸氢钠注射液,对照组造影术前1 h 按3 ml·kg-1·h-1速度静脉输注0.9%氯化钠注射液。对比分析2组术前、术后24 h、48 h 共3次血肌酐(SCr)、钾离子(K+)、碳酸氢根(HCO-3)、肾小球滤过率(glomerular filtration rate,GFR)、尿液 pH 值、尿转铁蛋白(transferrin,TRF)、胱抑素 C (cystatin C,Cys C)及同型半胱氨酸(homocysteine,Hcy)的差异。结果观察组患者 CIN 发生率、二级终点事件发生率及需要行血液透析的比例分别为2.44%、0.00%、0.00%,显著低于对照组11.47%、5.74%、4.92%,差异有统计学意义(P <0.05)。观察组术后24 h 的 SCr、Cys C、Hcy 水平分别为(82.28±22.16)μmol/L、(1.24±0.21)mg/L、(14.02±3.14)μmol/L,术后48 h 分别为(82.06±22.79)μmol/L、(0.82±0.11)mg/L、(8.02±2.45)μmol/L,显著低于术前(94.58±17.63)μmol/L、(1.98±0.25)mg/L、(17.25±4.28)μmol/L,GFR、HCO 3、K+、-TRF 水平术后24 h 分别为(99.04±28.53)ml·min-1·(1.73 m2)-1、(26.09±2.99)mmol/L、(5.22±0.34)mmol/L、(4.82±0.52)mg/L,术后48 h 分别为(102.34±38.49)ml·min-1·(1.73 m2)-1、(25.72±2.30)mmol/L、(6.02±0.50)mmol/L、(5.38±0.64)mg/L,显著高于术前(79.93±18.14) ml·min-1·(1.73 m2)-1、(24.03±4.18)mmol/L、(3.88±0.31)mmol/L、(2.69±0.48)mg/L,而对照组术后24 h SCr、GFR、HCO-3、K+、TRF 水平分别为(92.79±29.04)μmol/L、(85.64±34.88)ml· min-1·(1.73 m2)-1、(24.17±4.04)mmol/L、(4.02±0.26)mmol/L、(2.92±0.64)mg/L,术后48 h分别为(93.89±25.75)μmol/L、(90.88±29.39)ml·min-1·(1.73 m2)-1、(23.81±4.18)mmol/L、(4.25±0.33)mmol/L、(3.08±0.71)mg/L,与治疗前的(94.97±22.79)μmol/L、(79.51±20.34)ml· min-1·(1.73 m2)-1、(24.01±3.17)mmol/L、(3.91±0.35)mmol/L、(2.71±0.52)mg/L 比较无变化,差异无统计学意义(P >0.05)。结论对冠状动脉造影术后造影患者使用碳酸氢钠水化干预能降低 CIN 的发生率,有效地保护肾脏功能。
目的：探討碳痠氫鈉水化方案對冠狀動脈造影術後對比劑腎病(contrast-induced ne-phropathy,CIN)的預防作用。方法選取2013年7月至2015年7月在我院心血管內科行冠脈造影術的患者245例為研究對象,隨機分為觀察組123例以及對照組122例。觀察組患者造影術前1 h按3 ml·kg-1·h-1速度靜脈輸註1.25%碳痠氫鈉註射液,對照組造影術前1 h 按3 ml·kg-1·h-1速度靜脈輸註0.9%氯化鈉註射液。對比分析2組術前、術後24 h、48 h 共3次血肌酐(SCr)、鉀離子(K+)、碳痠氫根(HCO-3)、腎小毬濾過率(glomerular filtration rate,GFR)、尿液 pH 值、尿轉鐵蛋白(transferrin,TRF)、胱抑素 C (cystatin C,Cys C)及同型半胱氨痠(homocysteine,Hcy)的差異。結果觀察組患者 CIN 髮生率、二級終點事件髮生率及需要行血液透析的比例分彆為2.44%、0.00%、0.00%,顯著低于對照組11.47%、5.74%、4.92%,差異有統計學意義(P <0.05)。觀察組術後24 h 的 SCr、Cys C、Hcy 水平分彆為(82.28±22.16)μmol/L、(1.24±0.21)mg/L、(14.02±3.14)μmol/L,術後48 h 分彆為(82.06±22.79)μmol/L、(0.82±0.11)mg/L、(8.02±2.45)μmol/L,顯著低于術前(94.58±17.63)μmol/L、(1.98±0.25)mg/L、(17.25±4.28)μmol/L,GFR、HCO 3、K+、-TRF 水平術後24 h 分彆為(99.04±28.53)ml·min-1·(1.73 m2)-1、(26.09±2.99)mmol/L、(5.22±0.34)mmol/L、(4.82±0.52)mg/L,術後48 h 分彆為(102.34±38.49)ml·min-1·(1.73 m2)-1、(25.72±2.30)mmol/L、(6.02±0.50)mmol/L、(5.38±0.64)mg/L,顯著高于術前(79.93±18.14) ml·min-1·(1.73 m2)-1、(24.03±4.18)mmol/L、(3.88±0.31)mmol/L、(2.69±0.48)mg/L,而對照組術後24 h SCr、GFR、HCO-3、K+、TRF 水平分彆為(92.79±29.04)μmol/L、(85.64±34.88)ml· min-1·(1.73 m2)-1、(24.17±4.04)mmol/L、(4.02±0.26)mmol/L、(2.92±0.64)mg/L,術後48 h分彆為(93.89±25.75)μmol/L、(90.88±29.39)ml·min-1·(1.73 m2)-1、(23.81±4.18)mmol/L、(4.25±0.33)mmol/L、(3.08±0.71)mg/L,與治療前的(94.97±22.79)μmol/L、(79.51±20.34)ml· min-1·(1.73 m2)-1、(24.01±3.17)mmol/L、(3.91±0.35)mmol/L、(2.71±0.52)mg/L 比較無變化,差異無統計學意義(P >0.05)。結論對冠狀動脈造影術後造影患者使用碳痠氫鈉水化榦預能降低 CIN 的髮生率,有效地保護腎髒功能。
목적：탐토탄산경납수화방안대관상동맥조영술후대비제신병(contrast-induced ne-phropathy,CIN)적예방작용。방법선취2013년7월지2015년7월재아원심혈관내과행관맥조영술적환자245례위연구대상,수궤분위관찰조123례이급대조조122례。관찰조환자조영술전1 h안3 ml·kg-1·h-1속도정맥수주1.25%탄산경납주사액,대조조조영술전1 h 안3 ml·kg-1·h-1속도정맥수주0.9%록화납주사액。대비분석2조술전、술후24 h、48 h 공3차혈기항(SCr)、갑리자(K+)、탄산경근(HCO-3)、신소구려과솔(glomerular filtration rate,GFR)、뇨액 pH 치、뇨전철단백(transferrin,TRF)、광억소 C (cystatin C,Cys C)급동형반광안산(homocysteine,Hcy)적차이。결과관찰조환자 CIN 발생솔、이급종점사건발생솔급수요행혈액투석적비례분별위2.44%、0.00%、0.00%,현저저우대조조11.47%、5.74%、4.92%,차이유통계학의의(P <0.05)。관찰조술후24 h 적 SCr、Cys C、Hcy 수평분별위(82.28±22.16)μmol/L、(1.24±0.21)mg/L、(14.02±3.14)μmol/L,술후48 h 분별위(82.06±22.79)μmol/L、(0.82±0.11)mg/L、(8.02±2.45)μmol/L,현저저우술전(94.58±17.63)μmol/L、(1.98±0.25)mg/L、(17.25±4.28)μmol/L,GFR、HCO 3、K+、-TRF 수평술후24 h 분별위(99.04±28.53)ml·min-1·(1.73 m2)-1、(26.09±2.99)mmol/L、(5.22±0.34)mmol/L、(4.82±0.52)mg/L,술후48 h 분별위(102.34±38.49)ml·min-1·(1.73 m2)-1、(25.72±2.30)mmol/L、(6.02±0.50)mmol/L、(5.38±0.64)mg/L,현저고우술전(79.93±18.14) ml·min-1·(1.73 m2)-1、(24.03±4.18)mmol/L、(3.88±0.31)mmol/L、(2.69±0.48)mg/L,이대조조술후24 h SCr、GFR、HCO-3、K+、TRF 수평분별위(92.79±29.04)μmol/L、(85.64±34.88)ml· min-1·(1.73 m2)-1、(24.17±4.04)mmol/L、(4.02±0.26)mmol/L、(2.92±0.64)mg/L,술후48 h분별위(93.89±25.75)μmol/L、(90.88±29.39)ml·min-1·(1.73 m2)-1、(23.81±4.18)mmol/L、(4.25±0.33)mmol/L、(3.08±0.71)mg/L,여치료전적(94.97±22.79)μmol/L、(79.51±20.34)ml· min-1·(1.73 m2)-1、(24.01±3.17)mmol/L、(3.91±0.35)mmol/L、(2.71±0.52)mg/L 비교무변화,차이무통계학의의(P >0.05)。결론대관상동맥조영술후조영환자사용탄산경납수화간예능강저 CIN 적발생솔,유효지보호신장공능。
Objective To investigate the effects and preventive measures of the improvement of the contrast agent sodium bicarbonate hydrotherapy.Methods 245 cases of cardiology coronary angi-ography/intervention patients were divided into observation group (n = 123 )and control group (n =122)from October 2008 to March 2010.The observation group were treatmented with 3 ml·kg-1·h-1 infusion rate of 1 .25% sodium bicarbonate injection.The control group were preoperative imaging speed by 3 ml·kg-1·h-1 intravenous infusion of 0.9% sodium chloride injection.The levels of serum creatinine(SCr),potassium ion (K+ ),bicarbonate(HCO-3 ),glomerular filtration rate(GFR),urine pH value of two groups were compared before and after preoperative.Results CIN incidence observed in patients,the secondary endpoint occurred and the proportion required hemodialysis were 2.44%, 0.00%,0.00% was significantly lower than the control group 1 1 .47%,5.74%,4.92%,and the difference was statistically significant(P <0.05).Observation group after 24 hours SCr,Cys C,Hcy levels were(82.28±22.16)μmol/L,(1 .24 ±0.21 )mg/L,(14.02 ±3.14)μmol/L,after 48 hours were (82.06±22.79)μmol/L,(0.82±0.1 1)mg/L,(8.02 ±2.45)μmol/L was significantly lower than the preoperative(94.58±1 7.63)μmol/L,(1 .98±0.25)mg/L,(1 7.25±4.28)μmol/L,GFR, HCO 3 ,K+ ,TRF levels after 24 hours were(99.04±28.53)ml·min-1·(1 .73 m2 )-1 、(26.09±2.99) mmol/L、(5.22±0.34)mmol/L、(4.82±0.52)mg/L,after 48 hours were(102.34±38.49)ml·min-1 ·(1 .73 m2 )-1 、(25.72±2.30)mmol/L、(6.02±0.50)mmol/L、(5.38 ±0.64)mg/L was significantly higher than the preoperative(79.93±1 8.14)ml·min-1·(1 .73 m2 )-1 、(24.03 ±4.1 8)mmol/L、(3.88 ±0.3 1)mmol/L、(2.69 ±0.48)mg/L,while the control group after 24 hours,SCr,GFR,HCO-3 , K-+ ,TRF levels were(92.79± 29.04)μmol/L、(85.64 ± 34.88 )ml·min-1 ·(1 .73 m2 )-1 、(24.1 7 ± 4.04)mmol/L、(4.02 ± 0.26)mmol/L、(2.92 ± 0.64)mg/L,after 48 hours were (93.89 ± 25.75 )μmol/L、(90.88±29.39)ml·min-1·(1 .73 m2 )-1 、(23.81 ±4.1 8)mmol/L、(4.25 ±0.33 )mmol/L、(3.08±0.71)mg/L remained no significiant change compared with before treatment (94.97±22.79)μmol/L,(79.5 1 ±20.34)ml·min-1·(1 .73 m2 )-1 ,(24.01 ±3.1 7)mmol/L,(3.91 ±0.35 )mmol/L,(2.71 ±0.52)mg/L,the difference was not statistically significant(P >0.05 ).Conclusions For coronary angiography/intervention of patients undergoing angiography using sodium bicarbonate hy-dration intervention can reduce the incidence of CIN,the effective protection of kidney function.
