静脉水化联合碱化预防高危患者对比剂诱发肾病的作用

目的探讨静脉水化联合碱化治疗预防高危患者对比剂诱发肾病的临床效果。方法选择行经皮冠状动脉介入诊疗,对比剂肾病发生风险评分系统评分≥11分的患者80例,治疗组40例,给予0.9%氯化钠溶液1mL·kg-1·h-1的静脉注射12h,联合30mL碳酸氢钠快速静脉注射;对照组40例,仅给予0.9%氯化钠溶液1mL·kg-1·h-1静脉注射12h的水化治疗,比较两组治疗后生化检验结果和对比剂诱发肾病发生率。结果治疗组介入治疗后尿pH值及肾小球率过滤比对照组高,血清肌酐浓度比对照组低,差异有统计学意义7.11±0.72vs.5.46±0.61,P0.05;37.91%±7.48%vs.30.11%±7.54%,P0.05;(1.40±0.19)mg/Lvs.(1.69±0.22)mg/L,P0.05]。治疗组对比剂诱发肾病发生2例,占5%(2/40),对照组发生8例,占20%(8/40),两者比较,差异有统计学意义(P0.05)。结论静脉水化联合碱化治疗可更有效地防止高危患者经皮冠状动脉介入治疗后对比剂诱发肾病的发生。

Effect of preventing contrast-induced nephropathy with sodium bicarbonate and hydration in patients with high risk factors

Objectives To study the beneficial effect of preventing contrast induced nephropathy （CIN） with sodium bicarbonate and hydration in patients with high risk factors. Methods We divided 80 patients, who had performed percutaneous coronary intervention therapy with the score of CIN risk score system ≥ 11 scores, into therapy group （n= 40） and control group （n=40）. Patients in therapy group received single-bolus intravenous administration of sodium bicarbonate and hydration with sodium chloride treatment,while the control group received standard hydration alone treatment. We compared the concentration of serum creatinine （SCr）, glomerular filtration rate （GFR）, urine pH and incidence of CIN of the 2 groups. Results GFR and urine pH were higher in therapy group than those in control group and concentration of SCr was lower, differences were significant 7.11±0.72 vs. 5.46±0.61, P〈0.05; 37.91%±7.48% vs. 30.11% ±7.54%, P〈0.05 ; （1.40±0.19） mg/L vs. （ 1.69 ±0.22 ） mg/L, P〈0.05 ]. Incidence of C IN in therapy group was 5 % （2/40）, while in control group was 20% （8/40）, difference was significant （P〈0.05）. Conclusions Single-bolus intravenous administration of sodium bicarbonate and standard hydration can be more effective to prevent CIN than standard hydration alone in patients with high risk factors after percutaneous coronary intervention therapy.