N-乙酰半胱氨酸预防老年急性心肌梗死患者 PCI 术后造影剂肾病的临床研究

目的 探讨N-乙酰半胱氨酸在预防老年（年龄≥60岁）急性心肌梗死（AMI）患者急诊经皮冠状动脉内介入治疗术（PCI）后造影剂肾病（CIN）中的作用.方法 以2010年2月～2012年5月在北海市人民医院住院行急诊PCI的109例老年AMI患者为研究对象,随机分为水化＋N-乙酰半胱氨酸治疗组（观察组,n=55）和水化＋安慰剂治疗组（对照组,n=54）.两组均同时予水化治疗,观察组在入院后即刻口服N-乙酰半胱氨酸泡腾片1200 mg,术后3d,口服N-乙酰半胱氨酸泡腾片1200 mg,2次/d;对照组则于相应的时间给予安慰剂治疗.术后24、48、72 h测定两组患者血清尿素氮（BUN）、血清肌酐（Scr）、肾小球滤过率（GFR）水平.结果 观察组出现CIN 5例;而对照组发生CIN 14例,两组CIN发生率差异有统计学意义（P＜0.05）;两组血管再通时间、支架数、造影剂用量比较[（6.25±l.82）min、（1.93±0.87）个、（158.7±36.2）mL比（6.78±l.63）min、（1.78±0.58）个、（150.9±33.2）mL],差异均无统计学意义（P＞0.05）;观察组术后72 h BUN、Scr[（8.23±2.37）mmol/L、（110.50±17.21）μmol/L]低于对照组[（9.47±3.90）mmol/L、（122.66±19.91） μmol/L],GFR高于对照组[（69.09±19.03）mL/min比（60.12±24.57）mL/min],差异有统计学意义（P＜0.05）.结论 N-乙酰半胱氨酸应用于老年急诊PCI患者可减少CIN的发生,有效保护患者肾功能,值得进一步研究.

Clinical study of N-acetylcysteine in prevention of contrast-induced nephropathy after PCI in elderly patients with acute myocardial infarction

Objective To investigate the effect of N-acetylcysteine in prevention of contrast-induced nephropathy （CIN） after primary percutaneous intervention （emergency PCI） in elderly patients （aged ≥60 years） with acute myocardial infarction （AMI）.Methods 109 elderly patients with AMI who underwent emergency PCI from February 2010 to May 2012 in People＇s Hospital of Beihai City were selected as research objects.All patients were randomly divided into Hydration ＋ N-acetylcysteine treatment group （observation group,n =55） and Hydration ＋ placebo treatment group （control group,n =54）.Two groups were all given hydration therapy at the same time,the observation group was immediately given N-acetylcysteine effervescent 1200 mg （oral） after admission,In 3 days after PCI,patients were given N-acetylcysteine Effervescent Tablets 1200 mg （oral）,2 times/d; control group was given placebo treatment at the appropriate time.The blood urea nitrogen （BUN）,serum creatinine （Scr）,glomerular filtration rate （GFR） of two groups were detected in 24 h,48 h,72 h after PCI.Results After PCI,5 cases of CIN occurred in the observation group,while 14 cases of CIN occurred in the control group,the incidence of CIN between the two groups was significantly different （P ＜ 0.05）; the artery recanalization time,number of stents,contrast agent of two groups were compared [（6.25±1.82） min,（1.93±0.87） piece,（158.7±36.2） mL vs （6.78±1.63） min,（1.78±0.58） piece,（150.9±33.2） mL],the differences were not significant （P ＞ 0.05）; 72 hours after PCI,BUN,Scr of observation group [（8.23±2.37） mmol/L,（110.50±17.21） μmol/L] were lower than those in control group [（9.47±3.90） mmol/L,（122.66±19.91） μmol/L],GFR was higher that in control group [（69.09±19.03） mL/min vs （60.12±224.57） mL/min],the differences were significant （P ＜ 0.05）.Conclusion N-acetylcysteine applied in elderly patients with emergency PCI can reduce the CIN,effectively protect the patient＇s kidney function,which is worthy of further research.