碳酸氢钠静脉输注对造影剂肾病预防作用的研究

目的观察慢性肾脏病患者在围造影期随机应用生理盐水和碳酸氢钠两种不同干预方法后造影剂肾病的发生率，验证并比较两种预防方法的有效性。方法将拟行冠状动脉造影并伴有肾功能损害的患者，随机分为碳酸氢钠组和生理盐水组。两组分别从造影前6h开始给予1．5％碳酸氢钠注射液或0．9％氯化钠注射液，按2ml／（kg·h）速度静脉输注，最大速度≤150ml／h。造影中至造影结束后6h，以80ml／h速度继续静脉输注。造影剂均使用碘海醇，记录使用剂量。分别测定造影前和造影后24h、72h的血清肌酐、尿素氮，比较两组患者造影剂肾病的发生率。结果105例患者年龄43～88岁，平均（70．51士7．69）岁。两组患者在性别、年龄、BMI、合并糖尿病病史和高血压病史、eGFR、血脂和血糖水平、碘海醇用量上均无显著性差异。血清肌酐水平在造影前碳酸氢钠组高于生理盐水组（110．5±27．4）μmol／LVS（102．5±13．3）μmol／L，P=0．043]。两组患者共发生造影剂肾病8例（7．62％），其中碳酸氢钠组1例（1.82％），生理盐水组7例（14％），两组造影剂肾病的发生率具有显著性差异（P=0．026）。结论与0．9％氯化钠注射液比较，围造影期应用1．5％碳酸氢钠静脉滴注能进一步降低已有肾功能损害患者造影剂肾病的发生，有效地保护肾脏功能。

Prophylactic effect of infusion with sodium bicarbonate on preventing radiocontrast induced nephropathy

Objective To observe the incidence of radiocontrast induced nephropathy（RCN） in patients with chronic kidney disease and to compare the effect of sodium bicarbonate with sodium chloride on preventing RCN. Method 105 patients with chronic renal function insufficiencyeGFR〈60ml/（min · 1.73m^2） ]were randomly divided into two groups of sodium bicarbonate and sodium chloride before using contrast medium. An infusion was performed at rate 2ml/（kg·h）（maximal rate≤150ml/h） for 6 hours before Iohexol contrast, followed by an infusion of 80ml/h for 6 hours after the procedure of PTCA（percutaneous coronary angiocardio graphy）. Serum creatinine and urea nitrogen leve were measured at baseline before using contrast medium and 24 hour, 72 hour after using contrast medium. The incidence of RCN was compared between the two groups. Results The mean age of 105 patients was 70.51±7.69 years old（ranging from 43-88 years old）. There was no significant difference between two groups in age, sex,BMI,eGFR, the level of serum glucose, TRIG and cholesterol, concomitant of diabetes mellitus and hypertension,and dosage of contrast medium. Baseline serum creatinine of sodium bicarbonate group was slightly higher than that of sodium chloride group （ 1.25 ± 0. 31 ） mg/dl vs （ 1.16 ± 0.15） mg/dl, P = 0. 043 ]. Overall incidence of RCN was 7.62%（8/105）. The morbidity of RCN was 14% （7/50） in sodium ehlorid group while 1.82%（1/55） in sodium bicarbonate group. There was a significant difference in incidence of RCN between two groups （P= 0. 026）. Conclusions Hydration with sodium bicarbonate before contrast exposure is more effective than hydration with sodium chloride in the prevention of RCN.