尼可地尔联合水化对预防慢性肾功能不全患者对比剂肾病的作用观察

目的 探讨尼可地尔联合水化预防慢性肾功能不全患者对比剂肾病(CIN)的作用。 方法 收集拟行择期冠状动脉介入诊疗的不稳定性心绞痛合并慢性肾功能不全的患者52例,随机分为尼可地尔组26例和对照组26例。尼可地尔组于冠状动脉诊疗术前3 d开始每日口服尼可地尔5 mg,每天3次; 2组均按照常规水化方案执行,于术前1 d及术后1,2,3 d采集静脉血。比较2组患者的血肌酐(Scr)、胱抑素C(CysC)及肾小球滤过率(GFR)的变化。 结果 2组患者的术前GFR,Scr及CysC比较,差别均无统计学意义(P>0.05)。术后1,2,3 d,2组患者的GFR均较术前下降,其中术后1,2 d与术前比较差别有统计学意义(P<0.05); 术后2 d,尼可地尔组的GFR高于对照组(P<0.05)。术后1,2,3 d,2组患者的Scr及CysC水平均较术前增高,其中术后1,2 d与术前比较差别有统计学意义(P<0.05); 术后2 d,尼可地尔组的Scr及CysC水平低于对照组(P<0.05)。尼可地尔组未发生CIN,对照组发生CIN 4例(15.4%),2组差别有统计学意义(P<0.05)。 结论 尼可地尔联合水化预防CIN的作用优于单纯水化。

Effect of Nicorandil Combined with Hydration on Prevention of Contrast-inducedNephropathy in Patients with Chronic Renal Insufficiency

ABSTRACT: Objective To explore the effect of nicorandil combined with hydration on prevention of contrast-induced nephropathy in patients with chronic renal insufficiency. Methods A total of 52 patients with unstable angina combined with chronic renal insufficiency who were undergoing elective coronary interventional diagnosis and treatment in the department of cardiology were enrolled in this study. They were randomly divided into nicorandil group(26 cases)and control group(26 cases). Compared with the control group, the subjects in the nicorandil group began the daily oral nicorandil 5mg tid 3 days before the coronary diagnosis and treatment. According to the conventional hydration program, the venous blood in the two groups were collected 1 day before operation then 1 day, 2 days, and 3 days after operation. The levels of serum creatinine(Scr), cystatin C(CysC), and GFR were compared between thetwo groups. Results There was no significant difference in GFR, Scr or CysC preoperatively between the nicorandil group and the control group(P>0.05). The level of GFR in the two groups was in decline 1 day, 2 days and 3 days after operation while there was significant difference between postoperative 1 and 2 days and pre-operation, and the index in the nicorandil group was higher than that in the control group 2 days after the operation(P<0.05). Scr and CysC index in the groups were both increased 1 day, 2 days and 3 days after operation while there was significant difference between postoperative 1 and 2 days and pre-operation(P<0.05). The index of Scr and CysC in the nicorandil group was lower than that in the control group 2 days after the operation(P<0.05). No cases of contrast-induced nephropathy in the nicorandil group were found while there were 4 cases in the control group(15.4%), therefore, the difference between the two groups was significant(P<0.05). Conclusions Nicorandil combined with hydration is better than pure hydration on prevention of CIN.