低渗非离子型造影剂对肾功能影响的前瞻性研究

目的：了解较大剂量新型低渗非离子型造影剂进行血管造影时对肾功能的影响。方法：前瞻性随机观察了100例应用低渗非离子型造影碘普胺进行心血管和肾血管造影病人的肾功能变化,其中造影前肾功能正常者96例,异常者4例。于造影前后第1,3,5d分别监测血肌酐（Scr),内生肌酐清除率（Ccr),血,尿渗透压,24h尿钠,尿糖和尿酶。结果：肾功能正常的96例,用碘普罗胺造影后第1d尿γ－谷胺酰转肽酶（γ－GT）与造影前比差异有显著性（P＜0．05）,但于造影后第3d均恢复到影前水平,Scr与Ccr造影前,后比较差异无显著性。尿常规指标有加重者22例,均于造影后第3－5d恢复到造影前水平。造影前肾功能异常的4例,用碘普罗胺造影后第1,3dScr升高,Ccr下降,第5d恢复到造影前水平。结论：对肾功能正常者用碘普罗胺行血管造影后出现一过性尿酶增加,并出现尿糖,尿蛋白,第3－5d后恢复正常。肾功能轻度异常者用碘普罗胺造影后Ccr下降,经积极处理第5d亦可恢复到造影前水平。

A prospective study on the effects of low-osmolar and nonionic contrast media on renal functions

OBJECTIVE: To investigate the effects of contrast medium, especially large dose of Iopromide, on renal functions. METHODS: 100 hospitalized patients who were going to have cardiac or renal angiography were selected. 96 patients had normal renal functions and 4 had slightly abnormal renal functions. Scr, Ccr, urine gamma-GT and urine glucose were monitored on the first, third and fifth day after angiography. RESULTS: All the 100 patients were administered with Iopromide. Of the 96 patients with normal renal functions, all had elevated urine gamma-GT on the first day after giving Iopromide; the level returned to normal on the third day. There was no significant change of Scr and Ccr after angiography. Of the 4 patients with abnormal renal functions, all had significant change of Scr and Ccr after using Iopromide and the levels of both returned to pre-angiography level on the fifth day. CONCLUSIONS: In patients with normal renal functions, Iopromide may cause transient elevation of urine gamma-GT level and positive urine glucose. In patients with slightly abnormal renal functions, Iopromide may cause significant decrease of Ccr and increase of Scr. However, with proper treatment, these indexes may return to pre-angiography level on the fifth day after angiography.