碘普罗胺致急性肾衰竭

1例65岁男性2型糖尿病患者,因反应迟钝伴口齿不清入院。头颅磁共振成像示脑梗死(急性期),给予肠溶阿司匹林(0.1g,1次/d)、依达拉奉(30mg,1次/d)及甲钴胺等药物治疗。因胸部、腹部CT增强扫描,连续2d各使用造影剂碘普罗胺100ml(含碘30g),第3天出现双下肢水肿,尿量400ml/24h,随后无尿,静脉给予呋塞米未见好转。复查血肌酐475μmol/L,尿素氮24.5mmol/L。诊断为急性肾衰竭,考虑与碘普罗胺有关。连续血液透析治疗5d后,患者尿量增加,血肌酐降至284μmol/L。17d后血肌酐231μmol/L,尿素氮14.4mmol/L。患者双下肢水肿明显好转,出院。     

不同剂量辛伐他汀对急性冠状动脉综合征患者冠状动脉介入术后炎症因子的影响

目的:研究不同剂量辛伐他汀治疗对急性冠状动脉综合征(ACS)患者急诊经皮冠状动脉介入治疗(PCI)术后炎症因子水平的影响。方法:入选52例ACS患者,随机分为辛伐他汀20mg组和40mg组,共观察4周。两组患者PCI术前、术后14天、28天分别抽血查高敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)水平。结果:PCI术后第14天、第28天时40mg辛伐他汀组血清hs-CRP和FIB水平显著低于20mg辛伐他汀组。第14天时大剂量组和常规剂量组分别是hs-CRP(3.73±2.5)mg/Lvs(5.49±2.90)mg/L(P<0.05),FIB(2.67±0.98)g/Lvs(3.27±1.05)g/L(P<0.05)。第28天时两组分别是hs-CRP(1.99±1.07)mg/Lvs(3.10±1.78)mg/L(P<0.01),FIB(1.91±0.78)g/Lvs(2.39±0.71)g/L(P<0.05)。结论:较大剂量辛伐他汀能更显著降低血清hs-CRP和FIB水平,抑制PCI术后的炎症反应。     

碘普罗胺注射液致过敏反应

<正>1病例资料患者女性,51岁。因"间断胸闷、气短、心慌10年,加重2月"于2009年3月10日入院。既往史:"高脂血症、颈椎病"病史多年;曾因"子宫肌瘤"行子宫次全切除术;曾服用"磺胺类"药物有皮肤瘙痒史。查体:T36.3℃,BP110/70mmHg,神志清楚,颈软,颈静     

对急性冠状动脉综合征行PCI患者的护理干预效果

目的探讨护理干预对急性冠状动脉综合征(ACS)行经皮冠状动脉介入治疗(PCI)的护理效果。方法对118例行经皮冠状动脉介入治疗的急性冠状动脉综合征患者实施全程护理干预,总结护理效果。结果 118例行PCI治疗后的急性冠状动脉综合征患者115例术后恢复正常生活能力,2例因出院后并发心力衰竭生活不能完全自理,1例在出院1年后死亡。结论对急性冠状动脉综合征患者经PCI术后的患者要实施全程的护理干预,包括住院初期、术后无症状期及出院后,要有良好的患者家属配合,保证PCI术后患者的康复,提高治愈率,减少并发症,提高急性冠状动脉综合征患者的生存质量。     

碘普罗胺的合成

3-氨基-5-(2,3-二乙酰氧基正丙胺基甲酰基)-2,4,6-三碘苯甲酸(6)经与甲氧基乙酰氯反应、碳酸氢钠作用下水解后再经氯代得3-[(2-甲氧基)乙酰胺基]-5-(2,3-二羟基正丙胺基甲酰基)-2,4,6-三碘苯甲酰氯(4),4与N-甲基-2,3-二羟基丙胺反应制得碘普罗胺,总收率为80%(以6计)。     

碘普罗胺注射液的不良反应

碘普罗胺注射液是一种非离子型低渗性造影剂。可降低因高渗透压引起的不良反应;溶液呈中性,不会影响带电荷的蛋白质和细胞膜结构,也不干扰体内电解质的平衡;对红细胞、内皮细胞及体液影响小。适用于血管造影、脑和腹部 CT 扫描及尿道造影,因其性质稳定,使用简便,不良反应小于离子型碘造影剂,因而被广泛用于心血管造影。随着使用频率和使用量的增加,碘普罗胺注射液不良反应报告的病例也逐年增加。2012年,国家药品不良反应监测数据库共收到怀疑药品为碘普罗胺注射液的不良反应事件报告709例,其中严重报告157例（22．14％）。其严重报告病例中严重过敏反应较为突出,主要表现为过敏性休克、喉水肿、过敏样反应和呼吸困难等。现将碘普罗胺注射液近年引起的不良反应综述如下。     

碘克沙醇和碘普罗胺对2型糖尿病患者肾功能影响的临床观察

摘 要 目的：观察等渗造影剂(碘克沙醇)和低渗造影剂(碘普罗胺)对2 型糖尿病患者肾功能的影响。方法：拟行冠状动脉造影的糖尿病患者83 例随机分为碘克沙醇组与碘普罗胺组,所有患者于造影前1 d,造影后3 d、7 d检测血尿素氮（BUN）、血清肌酐（SCr）和尿微量白蛋白（mAlb）水平,比较两组的肾功能指标、造影剂肾病发生率和药品不良反应。结果：与造影前相比,碘普罗胺组造影后3 d的BUN、SCr和尿mAlb水平明显升高(P<0.05);造影后7 d,两组的BUN、SCr和尿mAlb水平与造影前无明显差异(P>0.05)。造影后3 d,碘克沙醇组的SCr、BUN以及尿mAlb水平均明显低于碘普罗胺组(P<0.05);碘克沙醇组药品不良反应及造影剂肾病的发生率均显著低于碘普罗胺组(P<0.05)。结论：与低渗造影剂碘普罗胺相比,糖尿病患者使用等渗造影剂碘克沙醇进行冠脉介入诊疗,造影剂肾病和其他药品不良反应发生率低,恢复周期较短,值得临床推广应用。     

稀释用碘克沙醇对冠心病合并慢性肾脏病患者经皮冠状动脉介入术后肾功能的影响

目的 观察稀释用碘克沙醇对冠心病合并慢性肾脏病(CKD)患者经皮冠状动脉介入术(PCI)后肾功能的影响及安全性。方法 回顾性选取2019年11月—2021年11月黄山昌仁医院收治的冠心病合并CKD患者52例,CKD分期:3期27例,4期22例,5期3例。患者均行PCI,术中选取碘克沙醇注射液作为对比剂,并以0.9%氯化钠溶液进行1∶1稀释后应用。记录患者手术情况,并比较不同分期患者术前及术后24～72 h血尿素氮(BUN)、血肌酐(SCr)及估算肾小球滤过率(e GFR),观察患者对比剂诱发的急性肾损伤(CI-AKI)等不良反应及严重不良心脑血管事件发生情况。结果 52例患者均顺利完成冠状动脉造影及PCI,且冠状动脉造影图像清晰,治疗成功率为100.0%。冠心病合并CKD患者术后e GFR高于术前(P <0.05);患者手术前后BUN、SCr比较,差异无统计学意义(P> 0.05)。亚组分析结果显示,冠心病合并CKD 4期患者术后BUN、SCr低于术前,e GFR高于术前(P <0.05);冠心病合并CKD 3、5期患者手术前后BUN、SCr、e GFR比较,差异无统...     

碘佛醇、碘克沙醇和碘普罗胺对充血性心力衰竭患者肾功能的影响

目的:观察碘佛醇、碘克沙醇和碘普罗胺对充血性心力衰竭患者肾功能的影响。方法:选取2017年3—12月入住首都医科大学宣武医院行强化CT的充血性心力衰竭患者198例,随机分为碘佛醇组64例、碘克沙醇组65例与碘普罗胺组69例。所有入组患者均在行强化CT检查前及检查后第5、10天查血肌酐(serum creatinine, SCr)、尿素氮(blood urea nitrogen, BUN)及尿微量白蛋白与肌酐比值(urinary albumin/creatinine ratio,mAlb/Cr),计算肾小球滤过率(estimated glomerular filtration rate, eGFR),比较3组肾功能指标变化及造影剂肾病(contrast-induced nephropathy,CIN)发生率。结果:强化CT检查5d后3组患者SCr、BUN及mAlb/Cr均较检查前升高(P<0.05),eGFR较检查前降低(P <0. 05)。检查10 d后碘佛醇组mAlb/Cr与eGFR、碘普罗胺组mAlb/Cr仍未恢复至检查前水平(P<0.05);强化CT检查5d后碘克沙醇组SCr、mAlb/Cr明显低于碘佛醇组(P<0.05), eGRF明显高于碘佛醇组(P<0.05);碘普罗胺组eGFR明显高于碘佛醇组(P<0.05)。碘佛醇组CIN发生率明显高于碘克沙醇组(P<0.05),但与碘普罗胺组CIN发生率无明显统计学差异(P>0.05)。结论:在充血性心力衰竭患者中选择等渗造影剂(如碘克沙醇)可以减低CIN发生率,造影剂黏度对CIN影响较小。     

ALB-dNLR评分对急性冠状动脉综合征患者行介入治疗预后的影响

目的 分析白蛋白-衍生的中性粒细胞与淋巴细胞比值（ALB-dNLR）评分对急性冠状动脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）预后的影响。方法 连续入选确诊ACS并行PCI的患者共1 744例,收集患者临床资料。患者出院后通过门诊复诊、电话等方式随访,记录其主要不良心血管事件（MACE）。采用受试者工作特征（ROC）曲线确定各炎性指标预测MACE的最佳界值。分析ALB和dNLR与各炎性指标的相关性。通过Kaplan-Meier曲线和Cox 回归模型分析患者发生MACE的影响因素。结果 共纳入1 539例患者,中位随访时间1 141 d,其中MACE组60例,Non-MACE组1 479例。MACE组中性粒细胞计数、dNLR、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、系统免疫炎性指数（SII）、肌酸激酶同工酶和肌酐水平均较Non-MACE组升高,而淋巴细胞计数、ALB水平较Non-MACE组下降。ALB、dNLR、ALB-dNLR、NLR、PLR、MLR、SII的ROC曲线下面积分别为0.619、0.600、0.645、0.619、0.576、0.587、0.611（均P<0.05）。dNLR与NLR、PLR、MLR、SII均呈正相关（均P<0.05）。ALB≤40.72 g/L、dNLR≥2.30和ALB-dNLR评分升高均为ACS患者PCI术后发生MACE的独立危险因素（P<0.05）。结论 ALB-dNLR评分是ACS患者PCI术后发生MACE的独立预测因素,有望成为预后评估的新型指标。     

Routine early versus deferred provisional tirofiban treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

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高龄急性冠脉综合征患者介入及药物治疗并发严重出血高危因素的研究

目的探讨高龄（≥75岁）急性冠脉综合征（ACS）患者介入及药物治疗并发严重出血发生率及其高危因素。方法高龄ACS患者162例,根据治疗方法分为经皮冠状动脉介入术（PCI）组121例及药物治疗组41例,比较2组间院内严重出血发生率,采用Logistic回归分析严重出血的独立危险因素。结果总体出血发生率为4.3%（7/162）,PCI组与药物治疗组出血发生率分别为4.8%（2/41）与4.1%（5/121）,2组比较差异无统计学意义（P〉0.05）。年龄〉80岁、氯吡格雷、替罗非班负荷治疗可增加严重出血发生风险。结论同药物治疗相比,PCI治疗未增加高龄ACS患者出血并发症。年龄〉80岁、氯吡格雷、替罗非班负荷治疗增加严重出血发生率。     

Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention

1. Inflammation is central to the pathogenesis of acute coronary syndrome (ACS) and is associated with adverse clinical outcomes after percutaneous coronary intervention (PCI). Recent in vitro work has demonstrated the anti‐inflammatory effect of berberine, a primary component of the traditional Chinese medicine ‘umbellatine’. In the present study, we further tested whether berberine had any beneficial effects on ACS patients following PCI. 2.In all, 130 ACS patients undergoing PCI were recruited to the present study. Sixty‐one patients were treated with berberine (300 mg, t.i.d., for 30 days) in addition to standard therapy, whereas the remaining patients received standard therapy alone. Circulating inflammatory markers were measured by ELISA, whereas serum lipid profiles were measured by routine chemical assays. 3.In the berberine‐treated group, matrix metalloproteinase (MMP)‐9, intercellular adhesion molecule (ICAM)‐1, vascular cell adhesion molecule (VCAM)‐1, C‐reactive protein, interleukin‐6 and monocyte chemoattractant protein‐1 were significantly reduced relative to baseline values. Furthermore, the changes in MMP‐9, ICAM‐1 and VCAM‐1 from baseline to after 1 month of treatment differed significantly between the two patient groups. There was a tendency for berberine to induce a slightly greater reduction in low‐density lipoprotein cholesterol and triglycerides than standard therapy alone, without affecting high‐density lipoprotein cholesterol, but the differences failed to reach statistical significance. No severe adverse effects of berberine were observed. 4.The results of the present study provide the first clinical evidence of the anti‐inflammatory action of berberine in ACS patients following PCI. Berberine may become adjunct therapy to further improve clinical outcomes via its anti‐inflammatory effect in ACS patients.     

The early percutaneous coronary intervention in elderly patients with acute coronary syndrome

It is challenging to undo early percutaneous intervention (PCI) in the elderly with acute coronary syndrome (ACS). Fifteen patients older than 65 years with ACS within 24 hours of the event were admitted from April 4, 2004 to December 12, 2005. All the patients had early percutaneous coronary intervention and were followed up for 6–12 months by telephone or in the out-patient department. Nine of the 15 patients exhibited acute myocardial infarction (AMI). Six exhibited unstable angina (UA). All the patients had early PCI. The average door-to-balloon time was 78 minutes (40–110 minutes). The average PCI time was 99 minutes (68–120 minutes). Nineteen of 36 lesions in the fifteen angioplasty patients were treated and 20 stents were implanted in total. All the procedures were considered successful. Neither deaths nor recurrent angina occurred in the 6–12 months of follow-up. It was shown that early PCI might be an effective and safe method to treat elderly patients with ACS.     

瑞舒伐他汀逆转颈动脉斑块与急性冠脉综合征介入治疗近期预后的关系

目的观察急性冠脉综合征（ACS）行经皮冠状动脉介入治疗（PCI）术的患者经瑞舒伐他汀降脂治疗后颈动脉斑块逆转程度与术后主要不良心血管事件（MACE）发生率之间的关系。方法180例急性冠脉综合征患者,予PCI术治疗,术前0—3d开始服用瑞舒伐他汀10mg／d,围术期（手术前后3d内）、术后6个月、12个月分别行颈动脉多普勒超声检查,按照颈动脉粥样斑块减轻的程度分为明显逆转组和无明显逆转组,随访12个月,比较2组患者MACE的发生率。结果明显逆转组患者MACE发生率低于无明显逆转组患者（随访6个月时10．2％VS．22．8％,P〈0．05;随访12个月时17．6％vs43．6％,P〈0．01）。结论瑞舒伐他汀逆转颈动脉斑块程度不一,有明显逆转的ACS患者PCI术后近期预后较好。     

急性冠脉综合征患者接受经皮冠状动脉介入治疗前后抗血小板策略

急性冠脉综合征(ACS)是一组由急性心肌缺血引起的临床综合征,包括不稳定型心绞痛(UA)、非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型心肌梗死(STEMI).ACS主要发病机制是动脉粥样硬化斑块破裂后,血小板激活和凝血酶的形成,最终导致血栓形成.目前抗血小板治疗和抗凝治疗是ACS患者抗栓治疗的两大重要组成部分.随着经皮冠状动脉介入治疗(PCI)的广泛应用,ACS患者PCI围手术期抗栓药物的安全性及有效性备受关注.本文就ACS患者有关接受PCI前后的抗血小板治疗策略的一些大型临床试验及抗血小板药物在当今早期侵入性冠状动脉治疗时代中的应用现状作一综述.     

The role of eptifibatide in patients undergoing percutaneous coronary intervention

Glycoprotein (GP) IIb/IIIa receptor antagonists inhibit the binding of ligands to activated platelet GP IIb/IIIa receptors and, therefore, prevent the formation of platelet thrombi. They have been extensively studied in patients undergoing percutaneous coronary intervention (PCI). Eptifibatide, one of the approved GP IIb/IIIa inhibitors, is a small heptapeptide that is highly selective and rapidly dissociates from its receptor after cessation of therapy. In clinical studies, concomitant administration of eptifibatide in patients undergoing elective PCI reduced thrombotic complications in the IMPACT-II (Integrilin to Minimize Platelet Aggregation and Prevent Coronary Thrombosis II) and ESPRIT (Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy) trials. In the PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) trial, which included 10,948 patients with non-ST-elevation acute coronary syndromes, eptifibatide significantly reduced the primary end point of death and non-fatal myocardial infarction at 30 days compared with placebo. In patients with ST-segment elevation myocardial infarction (STEMI), eptifibatide has been studied as adjunct to primary PCI and improved epicardial flow and tissue reperfusion. Studies are now evaluating eptifibatide in high-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS) and a planned early invasive strategy in the EARLY-ACS (Eptifibatide Administration prior to Diagnostic Catherization and Revascularization to Limit Myocardial Necrosis in Acute Coronary Syndrome) trial and in patients with primary PCI for STEMI in comparison to abciximab in the EVA-AMI (Eptifibatide versus Abciximab in Primary PCI for Acute Myocardial Infarction) trial. After the completion of these trials, the value of eptifibatide in patients undergoing PCI in different indications can be determined.     

比伐卢定在高龄经皮冠脉介入治疗急性冠脉综合征患者中的疗效及安全性观察

目的 探讨高龄急性冠状动脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）应用比伐卢定抗凝的疗效及安全性.方法 拟行PCI的年龄≥80岁ACS患者155例,随机分为比伐卢定组（78例）及普通肝素组（77例）.比较两组PCI术后24 h、30 d的主要心脑不良事件（MACCE）及出血发生率.结果 两组患者PCI术后24 h、30 d的MACCE发生率差异均无统计学意义（P〉0.05）.比伐卢定组患者术后出血发生率明显低于普通肝素组（P〈0.001）.结论 与普通肝素相比,比伐卢定在老年ACS接受PCI治疗的人群中,明显减少出血事件,且未增加MACCE发生率.     

Bivalirudin during percutaneous coronary intervention in acute coronary syndromes

Introduction: Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Unfractionated heparin (UFH), an injectable anticoagulant has several limitations: lack of predictability of its biological efficacy, platelets activation, heparin-induced thrombopenia and bleedings. Bivalirudin, a synthetic direct thrombin inhibitor has biological properties that promised better clinical outcome in ACS patients undergoing PCI.

Areas covered: The present review aimed to summarize two decades of randomized clinical trials that compared bivalirudin to UFH in ACS patients treated with PCI. Early trials highlighted a reduction of bleedings with bivalirudin compared to UFH in combination with glycoprotein inhibitors (GPI). Recent studies questioned this reduction given that GPI are less and less used during PCI. Further, trials raised concerns about the risk of stent thrombosis in patients treated with bivalirudin. In light of this data, bivalirudin has been downgraded in international guidelines and appears as a second line anticoagulant agent after UFH.

Expert opinion: The highly questioned reduction of bleedings under bivalirudin and the potential risk of stent thrombosis are unwarranted. Based on clinical trials, UFH has no equivalent in terms of anticoagulation in ACS patients undergoing PCI.