老年冠心病合并糖尿病患者造影剂肾损害的护理

目的研究血糖变化对老年冠心病合并糖尿病患者PCI（Percutaneous Coronary Intervention）术后造影剂肾损害的影响,并对这一人群采取相应的护理预防对策。方法回顾性分析住院行冠脉造影及介入治疗老年冠心病合并糖尿病患者70例,比较其造影前后血糖变化、血肌酐、eGFR之间的关系。结果本组肾损害总发生率8.5%,其中有糖尿病的发病率1%,糖尿病合并肾功能不全的患者中肾损害发生率15.6%。发生肾损害的患者中术后48hScr较术前逐渐增高。急性血糖升高患者中37.5%发生了肾损害,而血糖正常的糖尿病患者无肾损害发生。冠心病合并糖尿病伴肾功能不全患者介入后24h、48h后餐前、餐后血糖、血肌酐以及eGFR水平较介入前明显升高。结论对于老年冠心病合并糖尿病患者围手术期采取有效的护理预防措施,对于降低CIN的临床发生率有积极意义。     

冠脉介入治疗中造影剂肾病的预防与护理

目的探讨接受冠状动脉介入治疗的冠心病患者发生造影剂肾病（CIN）的预防及护理。方法收集212例行经皮冠状动脉介入（PCI）治疗冠心病患者的临床资料,分析CIN发生危险因素及其预防与护理方法。结果212例行经皮冠状动脉介入（PCI）治疗冠心病患者共发生CIN13例,其中合并糖尿病4例,慢性肾功能不全8例,高血压1例。经治疗后10例痊愈,3例好转。结论肾功能不全、糖尿病和造影剂剂量及种类是PCI术后造影剂肾病发生的危险因素,采取有效的早期预防和护理措施,对降低其发生、改善预后具有极为重要的意义。     

冠脉介入诊疗并发造影剂肾病的预防与护理

目的 探讨在冠脉介入诊疗过程中并发造影剂肾病(CIN)的预防和护理.方法 收集265例行冠脉介入造影诊疗患者的临床资料,分析CIN发生的危险因素及其预防与护理方法.结果 265例行介入造影诊疗的患者中合并糖尿病56例,慢性肾功能不全12例,高血压11例,慢性心功能不全3例.有11例有不同程度的造影剂肾损害,其中患糖尿病者3例,患慢性肾功能不全者6例,患高血压者1例,糖尿病合并慢性肾功能者1例,经积极治疗10例痊愈,1例好转.结论 肾功能不全、糖尿病、慢性心功能不全、高血压及造影剂剂量和种类是介入造影剂诊疗过程中造影剂肾病发生的危险因素;充分的水疗方法是预防本病的有效手段;重视造影剂肾病的危险因素,从术前评估危险因素,监测血糖、血压,水化治疗以及术后密切观察病情,做好个性化、系统化的护理,对减少造影剂肾病的发生、改善预后都具有重要意义.     

老年冠心病患者介入术后并发造影剂肾病的预防及护理

目的探讨老年冠心病患者介入术后并发造影剂肾病（CIN）的预防及护理。方法收集冠心病患者852例中21例老年并发CIN患者的临床资料,分析CIN发生危险因素及其预防与护理方法。结果 852例行冠心病患者共发生CIN 21例,稳定性心绞痛2例,不稳定性心绞痛7例,心肌梗死12例,合并糖尿病10例,慢性肾功能不全7例,高血压5例。经治疗后10例痊愈,3例好转。结论老年冠心病患者介入术后并发造影剂肾病发病率较高,危险性大,采取有效的早期预防和护理措施,对降低其发生、改善预后具有重要意义。     

瑞舒伐他汀预防冠心病合并糖尿病患者造影剂肾病的临床研究

目的：探讨瑞舒伐他汀预防冠心病合并糖尿病患者造影剂肾病的临床效果。方法：选取我院经冠状动脉造影证实主要冠状动脉存在严重狭窄同时行冠脉介入治疗的38例冠心病合并糖尿病患者为研究对象。随机分为对照组和观察组,两组均服用治疗冠心病与糖尿病的常规药物,观察组在此基础上加服瑞舒伐他汀。结果：对照组的Scr达到了（136.4±28.9）μmol/L远高于观察组的（104.4±9.3）μmol/L（P〈0.05）;对照组的Ccr为（70.3±6.9）ml/min,和观察组的（78.8±9.7）ml/min相比较低（P〈0.05）,两组比较具有统计学意义。结论：瑞舒伐他汀能够改善患者肾功能,对预防冠心病合并糖尿病患者造影剂肾病有重要意义。     

冠状动脉介入治疗中造影剂对肾功能损害的临床分析

目的 探讨造影剂在冠状动脉介入治疗中对肾功能的不良影响.方法 将我院行冠状动脉介入治疗术者360例,其中术前肾功能正常者240例,选用非离子低渗造影剂,术前肾功能异常者120例,使用等渗造影剂,并分别于实施介入治疗前、治疗后第1、2、6d检测肾功能指标.结果 术前肾功能正常者造影剂肾病发生率为4.58%;其患造影剂肾病者与未患造影剂肾病者在糖尿病,造影剂用量和术前补液量等方面具有显著差异(P＜0.05).术前肾功能异常者造影剂肾病发生率为1.67%;其患造影剂肾病者与未患造影剂肾病者在糖尿病,造影剂用量和术前补液量等方面也具有显著差异(P＜0.05).两种造影剂对肾功能的影响也存在差异.结论 等渗造影剂对冠状动脉介入治疗患者的肾毒性比低渗造影剂低,肾功能异常者在行冠状动脉介入治疗术时使用等渗造影剂更安全.     

慢性肾脏病合并急性冠状动脉综合征患者的危险因素与治疗策略

急性冠状动脉综合征(ACS)是慢性肾脏病(CKD)较为常见的并发症和死亡原因,两者关系密切。当CKD合并ACS时,临床处理时较为棘手。主要是因为:心肌缺血会导致肾脏供血不足,加重肾功能恶化,而行介入治疗后出现的造影剂肾病会造成肾脏二次打击;CKD合并ACS时,由于肾功能程度不同,对冠心病二级预防用药的耐受能力存在差异,是否介入治疗及调整药物剂量应用从而尽可能减少不良预后发生等值得进一步商榷。因此,针对这类患者处理策略存在众多误区,带来的结果是CKD患者发作ACS时,并未能得到有效的治疗。     

老年冠状动脉粥样硬化性心脏病合并慢性肾功能不全介入治疗安全性及疗效分析

目的 探讨老年冠状动脉粥样硬化性心脏病(冠心病)合并慢性肾功能不全(CRI)患者行经皮冠状动脉介入治疗(PCI)的安全性、临床特征及预后.方法 对50例CRI及50例肾功能正常的老年冠心病患者的基本临床特征、介入手术情况和肾功能变化等资料进行统计学分析.结果 ①两组患者年龄、性别构成、高血压、糖尿病等情况差异无统计学意义(P＞0.05),两组具有可比性;②MRI组造影剂肾病(CIN)发生率较对照组明显增加(P＜0.05),但1个月后血肌酐及肾小球率过滤均恢复术前水平,术后6个月复查较术前无明显升高(P ＞0.05);③MRI组患者冠状动脉病变以3支病变为多,对照组冠状动脉病变以2支病变为多.MRI组介入治疗实施困难,以接受优化药物治疗为主;④随访6个月,MRI组心血管不良发生率明显高于对照组.结论 老年冠心病合并CRI患者经围术期调整治疗方案可耐受PCI治疗,安全性较高.如冠状动脉病变较重,再血管化困难,预后较差.     

急性胰腺炎合并肾损害87例临床分析

目的探讨急性胰腺炎合并肾损害的临床特点及影响因素。方法回顾性分析急性胰腺炎311例的临床资料。结果并发肾损害87例,发生率28%,其中单纯肾损害47例,合并多器官功能损害40例（均有肾功能损害）。急性肾功能衰竭31例,发生肾损害时间：〈3 d 72例,〉3 d 15例。轻症急性胰腺炎合并肾损害者治疗3周内全部恢复正常,其中行血液透析26例。结论急性胰腺炎发病3 d内是出现肾损害的高峰期,尿量、尿常规、尿素氮是判断肾损害的重要指标,积极治疗原发病是治疗和预防急性胰腺炎并肾损害的重要措施,轻症急性胰腺炎并肾损害预后良好。     

造影剂致肾损害15例分析

随着现代影像诊断和介入治疗中造影剂的应用日益增多,造影剂所引起急性肾损害(又称造影剂肾病,简称CN)的发生率也明显增加.据统计,造影剂肾损害成为当前医院内发生急性肾功能衰竭第3位常见原因.因此,应引起临床医生的高度重视.本文总结了我院1990年1月至2005年4月行静脉肾盂造影(IVP)检查的986例患者,其中发现符合造影剂肾损害诊断标准15例,分析如下.     

姑息性肾动脉成形术用于严重冠心病合并肾动脉狭窄老年患者

OBJECTIVE: To investigate the feasibility of palliative percutaneous transluminal renal angioplasty (PTRA) and stenting in patients with serious coronary heart disease and renal arterial stenosis. METHODS: Thirty-four (23 male and 11 female) patients with a mean age of 61.0+/-11.8 years (ranging from 55 to 78 years) with serious coronary heart disease and renal arterial stenosis, who were unwilling or not suitable to undergo percutaneous coronary intervention and coronary artery bypass grafting, were enrolled in this study. All the cases underwent PTRA and were followed up for 17-53 months (average 35.0+/-9.3 months). The patients' renal and cardiac functions and left ventricular ejection fraction (LVEF) were measured in transthoracic echocardiography with the score of SF-36 Health Survey recorded. RESULTS: During the follow-up, the weekly incidence of angina pectoris reduced from 14.0+/-3.9 to 6.5+/-3.3 (P<0.01) and LVEF increased from (40.2+/-10.4)% to (45.3+/-7.8)% (P<0.05). The SF-36 scores were significantly improved from 56.5+/-8.0 to 80.1+/-16.8 (P<0.01), with also significant improvement in the subscales of health and daily activity, self-feeling, and general health. CONCLUSION: Palliative PTRA and stenting is feasible and necessary in elderly patients with serious coronary heart disease and renal arterial stenosis when percutaneous coronary intervention or coronary artery bypass graft therapy is not possible.     

肾动脉型大动脉炎的外科治疗

肾动脉型大动脉炎造成的难治性高血压及肾功能不全是大动脉炎药物治疗的难点,临床面临难治性肾血管性高血压且肾动脉狭窄程度≥70%时,应积极考虑行外科手术治疗。可选择的治疗方式有开放手术或介入治疗,但目前对于术式的选择尚无明确指南。本文总结了开放手术、球囊扩张术、支架置入术的临床效果、长期通畅率及并发症发生率,旨在为肾动脉型大动脉炎的临床手术术式选择提供参考。     

姑息性肾动脉成形术用于严重冠心病合并肾动脉狭窄老年患者

目的 探讨对严重冠心病合并肾动脉狭窄的老年病人姑息性单纯行肾动脉成形术及支架植入术(PTRA)的可行性。方法 选取2000年7月~2003年7月间严重冠心病合并肾动脉狭窄的未行冠脉搭桥及经皮冠脉成形术且单纯行PTRA治疗的病人共34例(男23人、女11人),并对病人心肾功能、心脏超声心动图观察左室射血分数(LVEF)以及SF-36调查表内容进行17~53个月[平均(35.0±9.3)月]的随访。结果 随访中心绞痛发作次数由每周(14.0±3.9)次发展为6.5±3.3次(P<0.01),LVEF从(40.2±10.4)%发展为(45.3±7.8)%(P<0.05);SF-36调查表中评分总分由56.5±8.0好转为80.1±16.8(P<0.01),评分中的健康和日常活动、自我感觉、总的健康情况部分也有明显好转(P<0.01)。结论 严重冠心病合并肾动脉狭窄病人,如病人按目前条件不能行冠脉搭桥或冠脉成形术,姑息性单纯行PTRA是必要且可行的方法。     

老年动脉粥样硬化性肾脏病的临床分析及支架置入治疗的效果评价

目的：探讨老年动脉粥样硬化性肾脏病临床特点，评价经皮肾动脉腔内成形及支架置入术对其的治疗效果。方法：回顾性研究我院1999年10月～2003年10月4年间经肾动脉造影确诊的所有38例老年动脉粥样硬化性肾脏病患者，对其临床特点进行总结分析；随访18例经过PTRAS治疗的疗效。结果：老年动脉粥样硬化性肾脏病患者多数伴随有高血压病、冠心病、高脂血症、糖尿病、周围血管病变等危险因素。临床上主要表现为血压升高、肾功能减退等。PTRAS安全性较高，能够改善老年动脉粥样硬化性肾脏病患者的症状，有效降低血压，延缓肾功能恶化。     

冠心病患者冠脉介入术后发生造影剂肾病的危险因素分析

目的探讨冠心病患者介入诊疗后造影剂肾病（CIN）发生的相关危险因素.方法选择120例接受PCI治疗的冠心病患者为研究对象,根据患者术后48h内的血清肌酐水平变化分为CIN组和非CIN组,并对相关危险因素进行分析.结果 120例接受PCI治疗的冠心病患者中有13例发生CIN,CIN发生率为10.83%,Logistic回归分析显示CIN的危险因素为肾功能不全、糖尿病和造影剂剂量及高龄.结论肾功能不全、糖尿病、造影剂剂量及高龄是PCI术后造影剂肾病发生的危险因素.     

Coronary stenting does not improve the long-term cardiovascular outcome of patients with mild to moderate renal insufficiency

Background Several studies have shown that coronary stenting reduces the frequency of clinical and angiographic restenosis in patients with mild to moderate renal insufficiency. However, less is known about the long-term benefits of stent use in this population. This study was aimed to determine the impact of coronary stenting on extended （5 years） long-term outcomes of patients with chronic renal insufficiency. Methods The study included 602 consecutive patients who underwent successful percutaneous coronary intervention with stenting. Renal insufficiency was defined as an estimated glomerular filtration rate 〈60 rrd.min-1-｜.73 m-2. The major adverse cardiac events were compared for patients with （n=160） and without （n=442） renal insufficiency. Results After the third year of follow-up, nonfatal myocardial infarction and revascularization rates were significantly increased in patients with renal insufficiency compared with those without renal dysfunction （16.9% vs 7.7%, P=0.001; 29.4% vs 15.8%, P 〈0.001）. In patients who had recurrent cardiovascular events, a significantly higher rate of de novo stenosis revascularization was found in patients with renal insufficiency than without renal insufficiency （57.7% vs 22.7%, P 〈0.001）, while there was no significant difference in target lesion revascularization between the groups （51.9% vs 43.6%, P=0.323）. Multivariate analysis demonstrated an independent impact of the presence of renal insufficiency on the major adverse cardiac events （hazard ratio： 1.488, 95% confidence interval： 1.051-2.106, P=0.025） and de novo stenosis （hazard ratio： 5.505, 95% confidence interval： 2.151-14.090, P 〈0.001）. Conclusions The late major adverse cardiac events, after successful coronary stenting, is increased in patients with an estimated glomerular filtration rate 〈60 ml.min-1.1.73m-2. This might be associated with increased risk of de novo stenosis in this population. Chin Med J 2009; 122（2）： 158-164     

冠状动脉病变支数及介入治疗对冠心病心功能的影响

目的:观察冠状动脉病变支数及介入治疗对冠心病病人心功能的影响。方法:对60例成功进行经皮冠状动脉成型和支架术的冠心病患者,术前和术后3月通过二维超声心动图观察冠状动脉病变不同支数组的左心室收缩功能的变化及对心功能的影响。结果:冠状动脉的病变支数与LVEF、FS值呈明显负相关;即冠状动脉病变累及越多,左室EF、FS值越低。术后各组左室射血分数及心功能分级均有不同程度改善。结论:冠状动脉的病变支数越多,左室收缩功能受损越明显。PC I能有效改善冠心病患者心脏收缩功能,减轻临床症状。     

冠心病患者介入治疗后血浆新型气体信号分子硫化氢及一氧化氮变化的临床研究

目的研究新型气体信号分子硫化氢(H2S)及一氧化氮(NO)在冠心病患者和冠脉造影正常者血浆中含量的差异及介入治疗对其的影响,探讨其在冠心病发病及介入治疗中的病理生理意义。方法冠心病组40例,造影正常组17例,采用硫敏感法测定术前血浆H2S含量并用Greiss法测定血浆中NO含量,动态监测冠心病患者冠状动脉造影前后、介入治疗后即刻、术后24h和72h血浆H2S、NO含量,分析冠心病组和造影正常组患者血浆H2S、NO含量的差异及介入治疗后血浆H2S和NO的变化。结果冠心病患者血浆H2S、NO含量远低于造影正常组(P均<0.01);冠脉双支和多支病变组血浆H2S含量差异无统计学意义(P>0.05),但均明显低于单支病变组(P<0.05和P<0.01)。不同支数病变冠心病患者血浆NO含量差异无统计学意义。冠脉血管有闭塞组其血浆H2S、NO含量明显低于单纯狭窄组(P均<0.05);支架植入术后复查狭窄者NO含量明显低于无狭窄者(P<0.05),H2S含量也低于无狭窄者,但差异无统计学意义(P>0.05)。冠状动脉造影术对血浆H2S、NO含量无影响,但PCI治疗术后即刻H2S、NO含量显著降低;H2S含量术后24h恢复至术前水平,NO含量术后24h降至最低水平,72h仍未恢复至术前水平。结论 H2S和NO可能参与了冠心病的发病过程及介入治疗后急性血管闭塞及再狭窄的发生,血浆H2S含量的高低与冠脉血管病变严重程度相关。     

Coronary artery stents

CONTEXT: Intracoronary stents are now used for the majority of patients undergoing percutaneous coronary revascularization, and the body of scientific knowledge about stents has expanded rapidly in the last several years. OBJECTIVE: To review the evidence supporting the widespread use of intracoronary stents. DATA SOURCES: The MEDLINE database was searched for articles from 1990 through January 2000 using the indexing terms stents, coronary artery disease, and angioplasty. Additional data sources included bibliographies of articles identified on MEDLINE, bibliographies in textbooks on percutaneous coronary interventions, and preliminary data presented at recent national and international cardiology conferences. STUDY SELECTION: We selected for review studies that assessed the effects of stenting on the immediate and long-term outcome of patients undergoing percutaneous coronary revascularization. If data from randomized controlled trials were not available for specific patient subsets or lesion characteristics, observational studies were included. DATA EXTRACTION: The methodologic characteristics of studies in coronary stenting were extracted and summarized according to key components of research design, including lesion type, location, and adjunctive therapy used. Studies were classified according to the strength of the available data into proven and unproven indications for stent use. DATA SYNTHESIS: Coronary artery stents increase the safety of interventional procedures, increase procedure success rates, and decrease the need for emergency coronary artery bypass graft surgery. CONCLUSIONS: Intracoronary stents have become an essential component of the catheter-based treatment of coronary artery disease. The evidence indicates that elective stenting, rather than provisional stenting or balloon angioplasty alone, improves clinical outcomes in the months following percutaneous coronary revascularization in a wide variety of clinical settings and lesion types. JAMA. 2000;284:1828-1836.