两种水化护理方法对行冠状动脉介入术后患者肾功能的影响

目的探讨两种水化护理方法对行冠状动脉介入术后患者肾功能的影响。方法选择2006年9月,2008年4月在本院心内科住院的肾功能轻度受损行冠状动脉造影术的患者56例,将患者随机分为常规水化组29例与强化水化组27例,分别观察两组患者造影前、造影后第3d及造影后第7d血浆肌酐水平及尿β2-微球蛋白水平。结果两组患者造影前血浆肌酐及尿β2-微球蛋白水平比较,均P〉0．05,差异无统计学意义;但两组在造影后第3d及第7d比较,均P〈0．05,差异具有统计学意义,常规水化组高于强化水化组。结论强化水化护理法较常规水化护理法能明显减少患者行冠状动脉介入术后造影剂引起的肾功能损害,值得临床推广应用。     

等渗与低渗造影剂对慢性肾功能不全患者肾毒性的对比研究

目的:对比等渗与低渗造影剂时不同程度慢性肾功能不全患者的肾脏损害程度.方法:回顾性分析我院收治的住院疑诊冠心痛行冠状动脉造影术或行经皮冠状动脉介入术的慢性肾功能不全病例350例,将350例患者按血清肌酐清除率分为CKD(慢性肾脏疾病)3期组、CKD 4期组及CKD 5期组,各组按所使用造影剂的不同分为两个亚组.比较手术前后各亚组间肌酐(SCr)浓度升高值、造影剂肾病的发生率以及尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)酶和β2微球蛋白浓度升高值的差异.结果:(1)CKD 3期组患者等渗与低渗造影剂亚组术后SCr浓度升高值、术后患者造影剂肾病的发生率、术后尿NAG酶和β2微球蛋白浓度升高值比较差异均无显著统计学意义.(2)CKD4、5期组患者中低渗造影剂亚组术后SCr浓度升高值、术后患者造影剂肾病的发生率、术后尿NAG酶和β2微球蛋白浓度升高值均显著高于等渗造影剂亚组.结论:在慢性肾功能不全患者中,等渗性造影剂比低渗性造影剂对血清肌酐清除率＜29%(CKD4-5期)的慢性肾功能不全患者有更低的肾脏毒性.     

碘克沙醇对高龄肾功能不全冠脉介入患者肾功能的影响分析

目的 探讨碘克沙醇对高龄肾功能不全冠脉介入患者肾功能的影响情况.方法 选择巩义市人民医院超过70岁的高龄伴有肾功能不全患者80例,均行冠脉介入手术,造影剂对照组选用碘普罗胺,观察组选用碘克沙醇,观察两组血清肌酐升高的幅度与造影剂肾病的发生情况.结果 对照组肌酐升高幅度高于观察组[（179.38 ±33.54）μmol/L vs （162.89±26.28） μmol/L,P＜0.05],造影剂肾病发生率高于观察组（28.21％ vs 5.13％,P＜0.05）,差异均有统计学意义.结论 采用碘克沙醇应用于高龄肾功能不全患者实施冠脉介入手术中安全有效,可减少造影剂肾病的发生率.     

预热碘克沙醇在冠状动脉造影和PCI术中的应用

目的:探讨预热碘克沙醇在冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）术中的安全性。方法:选取2014年1月—2019年12月于浙江省某三级甲等医院行CAG和PCI术中应用预热碘克沙醇的285例病人为研究对象,将其分为预热组和常温组,预热组将造影剂提前预热,常温组给予常温保存,比较两组注入药物即刻至术后7 d变态反应事件的发生率、术前2 h至术后48 h肌酐差值。结果:注入药物即刻至术后7 d内,预热组与常温组的变态反应发生率比较,差异无统计学意义（P>0.05）;预热组与常温组的手术前后肌酐差值比较,差异均无统计学意义（P>0.05）。结论:预热碘克沙醇在CAG和PCI术中应用安全性较好,在围术期至7 d随访期内安全性良好。     

移植肾功能不全患者肾活检术后的护理

肾移植是治疗慢性肾功能不全的有效手段之一，但据文献报道尸体肾移植术后肾功能不全的发生率仍然较高，其原因有多种，如急性排斥、慢性排斥、药物中毒等。通过病理活检可以鉴别、诊断移植肾功能异常的原因，制订合理的治疗方案。笔者对我所2003年1月-2005年12月因移植肾功能异常行肾活检患者的临床资料进行分析，探讨移植肾功能不全患者行肾活检术后的护理，现报道如下。     

尿酶对碘造影剂肾毒性的早期评估

前瞻性观察１６例肾功能正常患者造影前、造影后２４，４８ｈ肾功能动态变化。造影后２４ｈ血尿素氮（ＢＵＮ）、血清肌酐（ＳＣｒ）无显著变化（Ｐ＞０．０５）、尿谷氨酰转肽酶（γ－ＧＴ）、Ｎ－乙酰基－β－Ｄ氨基葡萄糖苷酶（ＮＡＧ）、乳酸脱氢酶（ＬＤＨ）较造影前显著增高（Ｐ＜０．０１）。造影后４８ｈＢＵＮ，ＳＣｒ显著增高（Ｐ＜０．０ｌ），尿γ－ＧＴ，ＮＡＧ，ＬＤＨ显著恢复（Ｐ＜０．０５）；但仍明显高于造影前，差异有显著性（分别Ｐ＜０．０１，０．０１，０．０５）。提示在肾功能正常患者泛影葡胺对肾小管损害呈一过性，尿γ－ＧＴ是评估碘造影剂肾毒性亚临床期敏感指标     

冠状动脉介入术患者造影剂肾病的预防护理

总结112例冠心病行冠状动脉介入术预防造影剂肾病的护理.认为护理重点是评估发生造影剂肾病的危险因素,积极控制诱因,加强病情观察,正确实施水化疗法,重视饮食护理和心理护理.112例患者中发生造影剂肾病27例,均好转出院.     

冠状动脉介入治疗对冠心病左心功能不全患者心功能的影响

目的探讨经皮冠状动脉介入(PCI)治疗对冠心病合并左心功能不全患者心功能的影响。方法选择62例行PCI的冠心病合并左心功能不全患者(PCI组),并选择同期基线资料相似的60例单纯应用药物治疗的冠心病合并左心功能不全患者作对照组。分别于PCI术前(或药物治疗前)及术后(或药物治疗后)6个月进行心脏彩色多普勒检测,比较2组心脏左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、左室射血分数(LVEF)及左室短轴缩短率(FS)的变化,并依据临床表现比较2组NUHA心功能分级的改变。结果2组患者治疗6个月后,彩色多普勒检测各项左心功能指标均较治疗前明显改善(P均<0.05),且PCI组治疗后与对照组比较,其LVDd〔(45.26±12.85)vs(47.71±13.09)mm〕、LVDs〔(29.75±0.91)vs(31.06±0.61)mm〕、LVEF〔(50.56±5.91)%vs(47.62±8.52)%〕和FS〔(28.15±2.98)%vs(23.98±3.05)%〕四项指标均优于对照组(P均<0.05)。PCI组患者心功能(NYHA)改善情况优于对照组。结论PCI治疗可明显改善冠心病合并左心功能不全患者的心功能。     

冠状动脉介入术中患者的护理

冠状动脉(冠脉)粥样硬化斑块稳定与否是导致急性心肌梗死,决定冠心病预后的重要因素[1].支架植入术是治疗冠脉斑块形成和狭窄的有效方法[2].光学相干断层成像系统(OCT)可以更直观、更精确地了解斑块的性质,判断斑块的稳定性,是精确判断血管病变的一项新兴诊断技术,尤其对冠脉临界病变是否需要植入支架,向医师提供重要的指导[3].行0CT技术检查的过程中,需要医护人员熟练配合并严密观察患者的各项生命体征变化,随时发现及时处理,以确保检查过程顺利,获得满意的图像.     

多普勒超声对慢性肾损害肾功不全各期肾血流动力学改变的研究

多普勒超声对慢性肾损害肾功不全各期肾血流动力学改变的研究谢玉环①张雪峰吴晓萍赵瑞英智淑清刘炯鹂本文旨在用多普勒超声观察慢性肾损害肾功衰竭不同时期，肾内各分级动脉血流动力学改变的情况。１资料与方法本文选正常对照组４６例，９２个肾，年龄在１６～７２岁，男...     

造影剂对冠脉造影患者肾功能的影响

目的 了解造影剂进行冠状动脉造影时对肾功能的影响。方法 前瞻性观察了141例应用非离子型低渗性造影剂碘海醇或等渗性造影剂碘克沙醇进行冠状动脉造影患者的肾功能变化，于造影前、造影后第1天、第2天分别测定血尿素氮（BUN）、血肌酐（SCr）、血胱抑素C（cystatin C，CysC）、尿微量白蛋白（mALB）、尿转铁蛋白（TRF）、α1-微球蛋白（α1-MG）、N-乙酰基-β-D氨基葡萄糖苷酶（NAG）及肌酐。结果 与造影前比较，造影后第1天血CysC显著升高（P〈0．01），超过正常范围，造影后第2天血CysC仍高于造影前水平（P〈0．01），但已降至正常范围；与造影后第1天比较，造影后第2天血cysC显著下降（P〈0．01）。血BUN、SCr及电解质造影前后无显著变化；与造影前比较，造影后第1天mALB、TRF、α1-MG和NAG均显著升高（P〈0．01），超过正常范围，造影后第2天，NAG仍显著高于造影前（P〈0．01），α1-MG仍高于造影前（P〈0．05），mALB和TRF恢复到造影前水平（P〉0．05）；与造影后第1天比较，造影后第2天mALB明显下降（P〈0．05），TRF、α1-MG和NAG均显著降低（P〈0．01）。结论 在无基线肾功能不全患者中，未见造影后发生CIN的病例，部分患者存在一过性轻度蛋白尿、尿酶升高；年龄与糖尿病可能是影响造影后第1天血CysC变化的主要危险因素。     

等渗碳酸氢钠和生理盐水水化在冠状动脉介入诊治中对肾功能影响的对比

目的对比观察等渗碳酸氢钠水化和生理盐水水化在冠状动脉介入诊治中对肾功能的影响。方法对2010年8月至2014年2月行冠状动脉介入诊疗的235例肾功能不全患者进行随机分组,将患者分为等渗碳酸氢钠组（n=112）与生理盐水组（n=123）。等渗碳酸氢钠组术前6 h给予充分等渗碳酸氢钠至术后18 h进行水化治疗;生理盐水组术前6 h给予充分生理盐水至术后18 h进行水化治疗,所有患者介入治疗后第1、3、5 d分别检查肾功能指标,并同时观察尿量,了解肾功能变化及造影剂相关性肾损害（CIN）的发生情况。结果两组患者在术后1、3、5 d与术前相比均有不同程度肌酐水平的升高,但等渗碳酸氢钠组较生理盐水水化组对肾功能的影响和CIN发生率低,差异有统计学意义（P均〈0.05）。结论等渗碳酸氢钠水化对肾功能的影响和造影剂肾病的发生率低。等渗碳酸氢钠水化预防肾功能不全患者发生CIN有效、副作用少。     

Effects of iohexol on ventilatory functions in patients undergoing diagnostic coronary angiography

Background and objectives Adverse respiratory reactions have been reported with intravascular radiographic contrast media. The aim of the present study is to assess the effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography (CA). Materials and methods: 30 patients enrolled in the study. The respiratory functions of the patients were measured at three different stages during angiography (before, immediately after and 2 h later) and arterial blood gas analyses were performed at six stages during CA (before, immediately after the insertion of angiography catheter, 2 min after the injection of contrast agent, at the end of angiography, an hour and 2 h after angiography). A single, experienced angiographer performed the angiography procedures via radial artery route. Totally six multiple angled views of the left and right coronary arteries were recorded in all patients by hand injection. None of the patients were performed ventriculography. Results: Angiography caused significant reduction in forced expiratory volume in 1 sec [FEV₁] (from 103 ± 15 to 95 ± 17, p < 0.01), forced vital capacity [FVC] (from 99 ± 13 to 95 ± 18, p < 0.05) and maximum mid-expiratory flow rate [MMF] (from 95 ± 33 to 84 ± 29, p < 0.01) whereas there were no significant changes in the mean FEV₁/FVC ratios at different stages of angiography. Statistically significant decrease in PaO₂ (from 91 ± 10 to 85 ± 13 mmHg, p < 0.01) and arterial O₂ saturation (from 97 ± 1% to 96 ± 1%, p < 0.01) were also observed. Data in present study showed a clinically insignificant but statistically significant restrictive impairment in pulmonary functions. Conclusions: Diagnostic CA using iohexol decreases ventilatory functions in a small but significant extent in patients without any overt pulmonary disease.     

Protective effects of anisodamine on renal function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

ST-segment elevation myocardial infarction (STEMI) is the most severe type of heart attack, and primary percutaneous coronary intervention (PCI) is the first line treatment for STEMI. However, these patients are at higher risk of contrast-induced nephropathy (CIN), which increases the length of hospital stay and mortality rate. Anisodamine, an alkaloid extracted from a Chinese herb, has been shown to exert protective effects on the renal function. The aim of this study was to investigate the protective effect of anisodamine on CIN in STEMI patients undergoing primary PCI. A total of 126 consecutive STEMI patients were randomly assigned to receive anisodamine (n=60) or placebo (control, n=66) from admission to 24 hours after PCI. The serum creatinine (SCr) concentrations, estimated glomerular filtration rate (eGFR) and incidence of CIN were measured on admission, and 24, 48 and 72 hours after PCI between the two groups. We found that the renal function of all patients after PCI underwent a course from injury to recovery. The incidence of CIN was 5.0%, 8.3%, and 6.7% at 24, 48 and 72 hours, respectively, after primary PCI in anisodamine group, while in control group it was 16.7%, 22.7%, and 19.7%, respectively. The incidence of CIN in anisodamine group was lower than that in control group during 72 hours after PCI (all P<0.05). In conclusion, intravenous infusion of anisodamine before and after primary PCI may reduce the occurrence of CIN in STEMI patients undergoing primary PCI, without serious side effects.     

冠状动脉造影术在动脉粥样硬化患者中应用的观察及护理

目的 探讨研究冠状动脉造影术在动脉粥样硬化患者解剖学观察中的应用及护理要点,进而通过对动脉粥样硬化形态的了解研究颈动脉发生粥样硬化形态结构的现状.方法 以2007年12月至2010年8月收治的拟诊冠状动脉粥样硬化性心脏病(CHD)患者78例为研究对象,并对围手术期的护理进行了总结.同期收治的10例CHD致死的老年患者进行了解剖研究.结果 临床共发生14例次并发症,但无患者因严重并发症死亡.结论 颈动脉和股动脉粥样硬化表现可以作为对冠状动脉粥样硬化进行研究的间接指标和窗口,而且右股动脉比左股动脉与双侧颈动脉的病变检出率更高.同时有针对性的临床护理,可降低术后并发症的危害.     

Comparison of carvedilol and metoprolol in patients with acute myocardial infarction undergoing primary coronary intervention

Summary Background The value of early therapy with beta-blocking agents in acute myocardial infarction (AMI) undergoing reperfusion is not yet well established. Newer beta-blocking agents such as carvedilol offer potential advantages in the setting of ischemia and reperfusion injury. Methods We randomized 100 patients with acute ST-elevation myocardial infarction (STEMI) to receive either 12.5 mg carvedilol or 50 mg metoprolol tartrate orally already before percutaneous coronary intervention (PCI) of the infarct-related artery, uptitrating to a daily target dose of 50 mg carvedilol or 150 mg metoprolol during the first week. Pts. were subjected to left ventricular (LV) angiography just before reperfusion and after 14 days to compare ejection fraction (EF) and regional wall motion abnormalities by quantitative LV analysis. Furthermore, kinetics of cardiac troponin T (cTnT), NT-proANP, NT-proBNP, endothelin, argenine vasopressin, epinephrine and norepinephrine were assessed during the first 12 hours and again at 2 weeks. In addition, reperfusion-induced rhythm abnormalities like VT, triplets, couplets, and bradycardic events were assessed continuously during the first 12 hours starting at reperfusion by Holter analysis. Results Both groups did not differ with respect to onset of pain, target vessel, extent of coronary heart disease, age, gender, rate of stenting or use of a GP IIb/IIIa inhibitor, pre- and postinterventional TIMI flow grade, time course of heart rate or blood pressure. There were neither significant differences in the cardiac and neurohumoral markers nor in the occurrence of arrhythmias between both treatment groups. Within 14 days, EF improved by 5.8±2.0% (mean±SEM) in the metoprolol group and by 5.2±2.1% in the carvedilol group (n.s.). Area of infarction was reduced by 6.1±2.9% in the metoprolol group and by 12.8±3.6% of total LV outline in the carvedilol group (n.s.). Maximum hypokinesia in the central infarcted region was diminished by 0.40±0.11 standard deviation (SD) in the metoprolol group and by 0.34±0.13 SD in the carvedilol group (n.s.). Conclusion In the setting of direct PCI in acute STEMI, administration of carvedilol before reperfusion appears not to be superior to metoprolol with respect to myocardial injury and improvement of global and regional LV function. The study documents equivalent improvement of LV function and similar kinetics of cardiac and neurohumoral markers in pts. with acute STEMI undergoing direct PCI if the pts. were immediately treated with either carvedilol or metoprolol. Thus, superiority of carvedilol in experimental studies did not translate into a clinical benefit.     

术后不同饮水方法对减轻冠状动脉介入术后造影剂相关性肾损伤的效果及护理

目的 探讨术后不同饮水方法 对减轻冠状动脉介入术后造影剂相关肾损伤的效果.方法 选择接受冠状动脉介入术患者94例,将研究对象分为自由饮水组(47例)和短期强化饮水组(47例),自由饮水组24h总饮水量不少于2000ml,但对单位时间饮水量无要求;短期强化饮水组要求其术后第1、2、3小时内每小时饮水400-500ml,24h总饮水量不少于2000ml.比较两组术前、术后血肌酐、尿素氮、血清β2-微球蛋白、尿微量白蛋白、24h出入量及有无尿潴留、胃部不适等情况.结果 短期强化饮水组与自由饮水组术后3h、13-24h入量、术后3h、6h、12h尿量、术后第l天尿微白蛋白和术后第1天尿微白蛋白差值比较有差异(P<0.05).结论 术后3h内强化饮水可减少冠状动脉介入术后患者造影剂相关肾损伤.     

瑞舒伐他汀与阿托伐他汀对冠脉介入术后肾功能的影响

目的 探讨瑞舒伐他汀与阿托伐他汀对冠脉介入术后肾功能的影响.方法 入选2012年1月至2012年12月在北京电力医院接受冠脉造影和（或）冠脉介入治疗患者100例,术前被随机分为2组,一组（瑞舒伐他汀组）术前开始服用瑞舒伐他汀10 mg每晚1次,术后服用10 mg每晚一次维持,共入组50例;另一组（阿托伐他汀组）术前开始服用阿托伐他汀20 mg,术后服用20 mg每晚一次维持,共入组50例,观察术后48小时的估算肾小球滤过率（estimated GFR）.结果 2组间比较,瑞舒伐他汀与阿托伐他汀对行介入后患者肾功能影响无明显差异,P＞0.05.结论 瑞舒伐他汀和阿托伐他汀均可提高肾小球滤过率,且两药对改善肾小球滤过率的作用没有显著差异,在eGFR＞60 ml/min/1.73 m2患者中介入前使用瑞舒伐他汀与阿托伐他汀是安全、有效的,值得在临床推广应用.     

不同温度下等渗对比剂对行冠状动脉介入治疗患者肾功能影响的研究

目的探讨在不同温度下等渗对比剂对行冠状动脉介入治疗患者肾功能的影响及其可能的机制。方法采用随机对照的研究方法,选择2014年1月至2015年9月在徐州市中心医院心内科住院行冠状动脉介入治疗的患者160例,随机分为常温组(80例)和温浴组(80例),两组患者使用的对比剂都是碘克沙醇,且都接受生理盐水水化。常温组对比剂在室温20℃情况下进行冠状动脉造影,温浴组将对比剂放入恒定温度37℃水浴箱,60 min后按冠状动脉造影常规进行操作。两组患者入院后常规测定基线血肌酐和血清胱抑素C,术后48~72 h之间再次采血测定血肌酐和血清胱抑素C,比较两组之间对比剂肾病(CIN)的发生率;同时比较两组之间术前、术后血清胱抑素C水平,使用SPSS 15.0统计软件进行数据分析。结果常温组患者的CIN发生率较温浴组升高(7.5%vs.6.3%),但差异无统计学意义(P=0.755)。常温组患者术后血清胱抑素C较术前的升高程度比温浴组更明显[(0.4±0.1)mg/L vs.(0.2±0.1)mg/L],两者之间差异有统计学意义(P<0.001)。结论水浴加温等渗对比剂碘克沙醇没有降低CIN的发生率,但是抑制了术后血清胱抑素C的升高。