充分水化联合精细化护理对预防经皮冠状动脉 介入术后对比剂肾病的作用

目的探讨充分水化疗法和精细化护理干预对于预防经皮冠状动脉介入（PCI）手术后病人并发对比剂肾病（CIN）的作用。方法选择冠心病支架置入术病人62例，随机分成干预组（31例）和对照组（31例）。对照组仅术后常规饮水并实施常规护理；干预组术后3 h充分饮水并实施精细化护理。重点监测病人术前和术后12~72 h血清肌酐（sCr）和胱抑素C（Cys-C）的水平。同时观察病人对其治疗效果和护理的满意度。结果干预组病人sCr和Cys-C水平在术前和术后5个时间点差异均无统计学意义（P>0.05）。而对照组病人sCr和Cys-C水平各时间点差异有统计学意义（P < 0.05）；sCr值术后72 h高于术前、术后12 h和术后24 h，Cys-C值术后72 h高于术前（P < 0.05~P < 0.01）。干预组病人干预后CIN发病率、胃部不适和尿潴留发生率均低于对照组（P < 0.05~P < 0.01）。干预组病人总满意率高于对照组（P < 0.05）。结论采用充分水化疗法和精细化护理干预对于PCI术后发生CIN、胃部不适和尿潴留有预防作用，能提高病人满意度，大大降低病人术后不适。

Effect of adequate hydration combined with refined care on the prevention of contrast-induced nephropathy after PCI

ObjectiveTo investigate the effects of adequate hydration combined with refined care on the prevention of contrast-induced nephropathy(CIN) after percutaneous coronary intervention(PCI).MethodsA total of 62 patients treated with PCI were randomly divided into the intervention group(31 cases) and control group(31 cases).The control group was treated with routine drinking water and nursing after operation, and the intervention group was treated with sufficient drinking water after 3 hours of operation combined with refined care.The levels of serum creatinine(sCr) and cystatin C(Cys-C) in two groups were detected before operation and after 12 h to 72 h of operation.The treatment effects and patients' satisfaction in two groups were observed.ResultsThe differences of the levels of sCr and Cys-C in intervention group among before operation and postoperative 5 time-points were not statistically significant(P>0.05), and the differences of the levels of sCr and Cys-C in control group among all time-points were statistically significant(P < 0.05).The level of sCr after 72 h of PCI was higher than that before operation and after 12 h and 24 h of PCI, and the level of Cys-C after 72 h of operation was higher than that before PCI(P < 0.05 to P < 0.01).The incidence rates of CIN, stomach upset and urinary retention in intervention group were lower than those in control group(P < 0.05 to P < 0.01).The satisfaction rate in intervention group was higher than that in control group(P < 0.05).ConclusionsThe adequate hydration combined with refined care intervention can prevent the CIN occurrence, stomach upset and urinary retention, improve the satisfaction after PCI, and greatly reduce the postoperative discomfort of patients.