非离子造影剂对老年冠状动脉造影患者肾功能的影响

目的观察非离子造影剂对老年冠状动脉(冠脉)造影患者肾功能的影响。方法选择具有冠脉造影适应证并行冠状动脉介入诊断、经皮冠脉介入治疗(PCI)的老年患者41例,年龄60~84(66±6)岁。于冠脉造影前、后第2天、第5天分别检查各项肾功能指标。以造影后2天内血清肌酐(Cr)比造影前增加44μmol/L或增加25%,或内生肌酐清除率(CCr)比造影前下降25%为诊断造影剂肾病的标准。结果PCI术后第2天血清尿素氮(BUN)、Cr、尿微量白蛋白浓度(UMALB)及24 h微量白蛋白总量(24 h UMALB)升高,24 h尿肌酐(UCr)、CCr较术前下降(P<0.05)。术后第5天上述指标与术前比较差异无显著性(P>0.05)。自由水清除率(free water clearance,CH2O)冠脉造影后第2天较术前升高(P<0.05),术后第5天未能恢复到术前水平(P<0.05)。按照造影剂肾病的诊断标准,共有8例患者可诊断造影剂肾病。结论非离子造影剂对行冠脉造影术的老年患者肾功能有一定损害,但多数属可逆性。

The effects of nonionic contrast media on renal function of elderly patients undergoing elective coronary angiography

Objective To investigate the effects of nonionic contrast media on renal function of elderly patients undergoing elective coronary angiography.Methods Forty-one elderly patients who were going to have coronary angiography and PCI were selected.All the patients were administered with ultravist(370).Cr,BUN,urine protein(PRO),urine β_2-microglobulin(β_2MG),urine micro-albumin(UMALB),Ucr,Ccr,free water clearance(CH_2O) were measured before angiography and on the second and fifth days after angiography.Results On the second day after angiography,Cr,BUN,urine micro-albumin(UMALB) were elevated and Ucr,Ccr decreased compared with those before angiography(P<0.05).On the fifth day,they all returned to the pre-angiography level(P>0.05).On the second day after angiography,CH_2O was elevated compared with that before angiography(P<0.05).It did not return to the normal level on the fifth day(P<0.05).Eight cases developed more than 25% decrease in Ccr within 48 hours after contrast administration.They were diagnosed as contrast medium-associated nephropathy(CAN).Conclusion In elderly patients undergoing coronary angiography,nonionic contrast media may cause adverse effects on renal function.However,most indexes may return to pre-angiography level on the fifth day after angiography.