急性冠脉综合征伴肾功能不全介入治疗的临床观察

目的 通过观察急性冠脉综合征（ACS）伴肾功能不全患者行经皮冠脉介入术（PCI）的预后,探讨行PCI对象的选择.方法 回顾2008年9月至2012年7月该院心内科确诊为ACS伴肾功能不全的患者行PCI术32例,按术后一月内是否行透析治疗分为两组：未透析组（n=8）;透析组 （n=24）.观察比较两组患者基本资料,心电图特点,心脏超声,急性心衰发生率,肾功能不全原因,肾脏超声,24 h尿蛋白,造影剂肾病,短期肾功能急性加重发生率差异.结果 两组性别、高血压、糖尿病、高脂血症、左室射血分数、24 h尿蛋白、造影剂肾病发生率差异无统计学意义（P〉0.05）.两组年龄差异有统计学意义（P〈0.05）,未透析组年龄小于透析组.短期肾功能损害加重发生率差异有统计学意义（P〈0.05）,未透析组大于透析组.结论 急性冠脉综合征伴肾功能不全患者,行PCI术风险较大,预后不良.但当这类患者有心肌缺血所致的急性心功能不全引起的短期肾功能损害加重时,行PCI能降低透析率,改善患者的预后,获益大.

Acute coronary syndrome associated with renal dysfunction involved in the clinical observation

Objective To discuss who suits PCI through the observation of the prognosis of acute coronary syndrome （ACS） with renal insufficiency patients who accept PCI. Methods All patients were chosen from the Department of Cardiology in Renmin Hospital of Wu- haM University within the period of September,2008-July,2012 ,whose final diagnosis is acute coronary syndrome and chronic renal insuf- ficiency. They were divided into 2 groups according to whether they accepted dialysis after undergoing PCI one month： nonuse dialysis group （ n = 8 ） ; and dialysis group （ n = 24）. We analyzed the basic information, including age, gender, blood pleasure, blood sugar et al, and compared electrocardiogram characteristic, echocardiogram, acute heart failure rate, the reason of renal insufficiency, kidney ultra- sound,24-hour urinary protein and contrast induced nephropathy and recorded short-term acute exacerbation of renal function. Results In both nonuse dialysis group and dialysis group, there were no significant differences in gender, high blood pressure, diabetes, hyperlipi- demia,left ventricular ejection fraction ,24-hour urinary protein and contrast indneed nephropathy incidence （P 〉 0.05 ）. The age was younger in the nonuse dialysis group than that in the dialysis group（ P〈 0.05 ）. Fewer patients had short-term acute exacerbation of renal function in dialysis group than in nonuse dialysis group （ P 〈 0.05 ）. Conclusions The patients suffering from acute coronary syndromes with chronic renal insufficiency, who accepted PCI, have high risk and poor prognosis. Nevertheless,when the short-term acute exacerba- tion of renal function becomes worse due to acute heart failure caused by recurrent ischemia, it the patients accepted PCI, it can reduce the incidence of dialysis and improve the prognosis.