连续性血液净化预防造影剂肾病的疗效观察

目的 探讨在原有肾功能不全的病人中造影后立即给予预防性血液透析滤过能否预防造影剂肾病的发生。方法 对我院1998～2003年46例有肾功能不全的病人使用造影剂(碘普罗胺)行造影后(CT、IVP、冠脉造影)进行分析。46例病人分为两组，其中一组(20例)给予常规治疗，另一组(26例)于造影后立即给予12～16h持续性静脉-静脉血液透析滤过(CVVHDF)，单次治疗，分析此两组病人造影后的肾功能的变化、需要暂时肾替代治疗的频率、造影临床相关事件(肺水肿、心肌梗死、休克)的发生率以及患者住院期间的病死率。结果 常规治疗组造影剂肾病发生率9／20(45％)，而HDF组造影肾病发生率为2／26(8％)(P＜0．01)，常规治疗组需暂时肾替代治疗(血透或血滤)的发生率为7／20(35％)，而HDF组需暂时肾替代治疗的发生率为1／26(4％)(P＜0．05)，常规治疗组造影临床相关事件(肺水肿、心肌梗死、休克)的发生率为9／20(45％)，HDF组为1／26(4％)(P＜0.01)，常规治疗组住院病死率为3／20(15％)，而HDF组住院病死率为1／26(4％)(P＜0．05)。结论 对于原有肾功能不全的病人在给予X线造影后立即给予预防性血液透析滤过可以有效地阻止造影剂对肾功能的损害，并可明显改善患者的预后。

Prevention of contrast media-induced renal dysfunction by continuous venovenaus hemodiafiltration

Objective To explore whether radiocontrast nephropathy can be avoided by prophylactic hemodiafiltration immediately after the administration of contrast media in patients with impaired renal functionMethods We retrospectively analyzed 46 in-hospital patients with impaired renal function after contrast medium injection(1998-2003)Patients were randomly assigned to either hemodiafiltion group (n=26)or routine treatment group (n=20)after the administration of low-osmolality contrast mediaThe renal function,the rate of in-hospital events(pulmonary edema,myocardial infarction,shock),in-hospital mortality and temporary renal-replacement therapy were observed after the administration of contrast mediaResults The incidence of contrast-agent-induced nephropathy was 45 percent of the patients in the routine treatment group,and 8 percent in the HDF treatment group(P<005)Temporary renal-replacement therapy(hemodialysis or hemofiltration)was required in 35 percent of the control group and in 4 percent of the HDF group(P<005)The rate of in-hospital events was 45 percent in the control group and 4 percent in the HDF group(P<001)In-hospital mortality was 15 percent in the control group and 4 percent in the HDF group(P<005)Conclusion In patients with chronic renal failure who are undergoing percutaneous coronary interventions,prophylactic HDF appears to be effective in preventing the deterioration of renal function due to contrast-agent -induced nephropathy and is associated with improved in-hospital outcomes