口服和静脉水化对对比剂肾病影响的研究

目的探讨口服和静脉两种不同方式的水化对对比剂肾病（contrast-inducednephropathy，CIN）发病率的影响。方法选择2009年12月-2010年8月心内科住院患者90例，随机分为口服水化组和静脉水化组，口服水化组术前6h到术后6h饮水l，500mL，静脉水化组术前6hN术后6h以lmL／kg／h速度给予0．9％生理盐水维持静滴；两组患者入院后常规测定基线血肌酐（serumcreatinine。Scr）水平，术后48-72h再次采血测定Scr，若发现Scr相对值升高25％或绝对值升高0．5mg／dL，则诊断为对比剂肾病，比较两组之间对比剂肾病的发生率。结果两组患者的对比剂肾病发病率不同，静脉水化组患者对比剂肾病发病率较口服水化组低．且有统计学差异（P〈0．05）。结论冠脉造影或PCI术前和术后静脉滴注生理盐水的水化治疗较口服水化降低了患者对比剂肾病的发病率。

Study on Effect of Oral Hydration and Venous Hydration to Contrast-induced Nephropathy

Objective To investigate the impact of oral hydration and venous hydration on the morbidity of CIN. Methods Ninety patients are selected from Cardiology Department of Xuzhou Hospital attached to Southeast University Clinical Medical School from Dec.2009 to Aug.2010.The ninety patients are randomly divided into two groups.The group A,referred to as the oral hydration group,is treated with drinking water 1,500mL between 6 hours before the surgery and 6 hours after the surgery.The group B,referred to as the venous hydration group,is treated with 0.9% normal saline to keep dripping at the speed of lmL/kg/h between 6 hours before the surgery and 6 hours after the surgery. The two groups receive the test of serum creatinine（Scr） at the beginning and are tested again Scr level 48 - 72 hours after the surgery.If the relative value of Scr increase 25% or the absolute value raises 0.5mg/dL,the patient is treated as CIN.The morbidity of CIN between two groups is compared with the statistic data. Results The percentage of CIN is different between two groups：the venous hydration group have the lower percentage than oral hydration group and there is significant statistic difference（P 〈 0.05）.Conclusion Hydration using 0.9% normal saline before and after cardiac angiography or PCI can help lower the percentage of CIN against hydration using drinking.