急诊PCI术后口服水化治疗预防造影剂肾病的水化用量选择与临床效果研究
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摘要
目的观察急诊经皮冠状动脉介入治疗(PCI)术后口服水化治疗预防造影剂肾病的水化用量选择及临床应用效果。方法选取2015年7月～2018年4月我院接收的急性心肌梗死行急诊PCI患者150例为研究对象,随机分为观察组和对照组,各75例。对照组实施术后6h常规口服水化剂量(1ml/kg/h)。观察组实施术后6h强化口服水化剂量(3ml/kg/h)。于术前、术后24h、48h、72h观察血肌酐与尿素氮变化情况,临床治疗效果及造影剂肾病发生率。结果两组术前血肌酐值与尿素氮值比较差异无统计学意义(P>0.05)。两组术后血肌酐值与尿素氮值比较差异有统计学意义(P<0.05)。两组术后造影剂肾病发生率比较差异有统计学意义(P<0.05)。两组治疗效果比较差异有统计学意义(P<0.05)。结论对急诊PCI术后患者实施口服水化治疗方式,能够安全有效实现对血肌酐和尿素氮的控制。而实施强化口服水化剂量(3ml/kg/h)在降低患者造影剂肾病发生率方面更优于常规口服水化剂量(1ml/kg/h),对于提高临床治疗效果具有重要的作用,应用价值突出。
Objective To observe the effect and clinical value of different oral hydration dosage after emergency PCI in preventing contrast-induced nephropathy. Methods 150 cases of patients with emergency PCI received in our hospital from July 2015 to April 2018 were randomly selected for exploration. All patients were divided into observation group and control group by random sampling, with 75 cases each. Control implementation of 6 hours after conventional oral hydration dose(1 ml/kg/h), observation group implementation after 6 hours to strengthen oral hydration dose(3 ml/kg/h). Observe the patient's serum creatinine and urea nitrogen values, and calculate the patient's estimated glomerular filtration rate in the preoperative and postoperative 24 hours, 48 hours and 72 hours respectively and also observe the incidence of postoperative contrast nephropathy within 72 hours. Results There was no difference between the observation group and the control group in preoperative serum creatinine and urea nitrogen(P>0.05). Postoperative serum creatinine and urea nitrogen were different between the two groups(P<0.05). The incidence of postoperative contrast nephropathy was different between the two groups(P<0.05). The treatment effect of the two groups was significant(P<0.05). Conclusion Oral hydration treatment for emergency PCI in patients with postoperative can effectively achieve the control of serum creatinine and urea nitrogen, and implementation to strengthen oral hydration dose(3 ml/kg/h) in reducing the incidence of contrast nephropathy patients with more superior to the conventional oral hydration dose(1 ml/kg/h), play an important role to improve the effect of clinical treatment and application value.
Objective To observe the effect and clinical value of different oral hydration dosage after emergency PCI in preventing contrast-induced nephropathy. Methods 150 cases of patients with emergency PCI received in our hospital from July 2015 to April 2018 were randomly selected for exploration. All patients were divided into observation group and control group by random sampling, with 75 cases each. Control implementation of 6 hours after conventional oral hydration dose(1 ml/kg/h), observation group implementation after 6 hours to strengthen oral hydration dose(3 ml/kg/h). Observe the patient's serum creatinine and urea nitrogen values, and calculate the patient's estimated glomerular filtration rate in the preoperative and postoperative 24 hours, 48 hours and 72 hours respectively and also observe the incidence of postoperative contrast nephropathy within 72 hours. Results There was no difference between the observation group and the control group in preoperative serum creatinine and urea nitrogen(P>0.05). Postoperative serum creatinine and urea nitrogen were different between the two groups(P<0.05). The incidence of postoperative contrast nephropathy was different between the two groups(P<0.05). The treatment effect of the two groups was significant(P<0.05). Conclusion Oral hydration treatment for emergency PCI in patients with postoperative can effectively achieve the control of serum creatinine and urea nitrogen, and implementation to strengthen oral hydration dose(3 ml/kg/h) in reducing the incidence of contrast nephropathy patients with more superior to the conventional oral hydration dose(1 ml/kg/h), play an important role to improve the effect of clinical treatment and application value.
引文
[1] 陶娟,康立惠,孙俊平,等.经皮冠状动脉介入术前后口服水化补液预防CIN效果观察[J].中国循证心血管医学杂志,2017,9(11):1352-1353.
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[7] 李然,王德良,王文素.术前强化阿托伐他汀联合充分水化疗法对PCI术后并发造影剂肾病的影响[J].河北医科大学学报,2017,38(3):262-265.
[8] 曹宇清,云峰,张晓琴.标准化口服水化方式预防下肢CT血管成像检查对比剂肾病的效果[J].实用临床医药杂志,2017,21(16):103-105.
[9] Liang M,Yang S,Fu N.Efficacy of short-term moderate or high-dose rosuvastatin in preventing contrast-induced nephropathy:A meta-analysis of 15 randomized controlled trials[J].Medicine,2017,96(27):e7384.
[10] 刘立艳,李艳,万业达,等.不同水化方式对肾功能正常人群预防对比剂肾病效果的研究[J].护士进修杂志,2016,31(17):1548-1550.
[11] Cooper CL.Outcomes of peginterferon alpha-2a and ribavirin hepatitis C therapy in Aboriginal Canadians[J].Canadian Journal of Gastroenterology,2016,22(8):677-680.
[12] Bouzas-Mosquera A,Vazquez-Rodriguez JM,Calvino-Santos R,et al.Contrast-induced nephropathy and acute renal failure following urgent cardiac catheterization:incidence,risk factors and prognosis[J].Rev Esp Cardiol,2007,60(10):1026-1034.
[13] Senoo T,Motohiro M,Kamihata H,et al.Contrast-induced nephropathy in patients undergoing emergency percutaneous coronary intervention for acute coronary syndrome[J].Am J Cardiiol,2010,105(5):624-628.
[14] 沈虹,江开航,梁秀梅.水化联合小剂量利尿剂预防高危患者对比剂肾病的研究[J].临床放射学杂志,2017,36(6):894-897.
[2] 徐猛,许良兰,章福彬,等.阿托伐他汀联合水化预防冠状动脉介入术后造影剂肾病的临床研究[J].内科急危重症杂志,2017,23(6):472-475.
[3] 马玉凤,张克森,杨世诚,等.强化阿托伐他汀联合水化对冠心病患者介入治疗后造影剂肾病的预防及护理[J].护士进修杂志,2018,33(5):.465-468
[4] Matsunami T,Hino K,Dosho R,et al.Efficacy of oral supplemental hydration for the prevention of contrast-induced nephropathy in rats[J].Japanese Journal of Radiology,2017,35(4):1-7.
[5] 冯艮娇,罗思妮,钟志安,等.不同口服水化护理对冠状动脉慢性完全闭塞病人造影剂肾病的影响[J].护理研究,2017,31(28):3573-3575.
[6] Nijssen EC,Rennenberg RJ,Nelemans PJ,et al.Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING):a prospective,randomised,phase 3,controlled,open-label,non-inferiority trial[J].Lancet,2017,161(10076):1312-1322.
[7] 李然,王德良,王文素.术前强化阿托伐他汀联合充分水化疗法对PCI术后并发造影剂肾病的影响[J].河北医科大学学报,2017,38(3):262-265.
[8] 曹宇清,云峰,张晓琴.标准化口服水化方式预防下肢CT血管成像检查对比剂肾病的效果[J].实用临床医药杂志,2017,21(16):103-105.
[9] Liang M,Yang S,Fu N.Efficacy of short-term moderate or high-dose rosuvastatin in preventing contrast-induced nephropathy:A meta-analysis of 15 randomized controlled trials[J].Medicine,2017,96(27):e7384.
[10] 刘立艳,李艳,万业达,等.不同水化方式对肾功能正常人群预防对比剂肾病效果的研究[J].护士进修杂志,2016,31(17):1548-1550.
[11] Cooper CL.Outcomes of peginterferon alpha-2a and ribavirin hepatitis C therapy in Aboriginal Canadians[J].Canadian Journal of Gastroenterology,2016,22(8):677-680.
[12] Bouzas-Mosquera A,Vazquez-Rodriguez JM,Calvino-Santos R,et al.Contrast-induced nephropathy and acute renal failure following urgent cardiac catheterization:incidence,risk factors and prognosis[J].Rev Esp Cardiol,2007,60(10):1026-1034.
[13] Senoo T,Motohiro M,Kamihata H,et al.Contrast-induced nephropathy in patients undergoing emergency percutaneous coronary intervention for acute coronary syndrome[J].Am J Cardiiol,2010,105(5):624-628.
[14] 沈虹,江开航,梁秀梅.水化联合小剂量利尿剂预防高危患者对比剂肾病的研究[J].临床放射学杂志,2017,36(6):894-897.