摘要
目的了解ST段抬高性心肌梗死(STEMI)患者应用低渗非离子造影剂直接PCI后造影剂肾病(CIN)的发病率及危险因素。方法2004年10月至2007年3月期间在北京友谊医院及首都医科大学大兴医院接受直接PCI的STEMI患者236例,所有患者均应用低渗非离子造影剂。测定介入治疗前和术后第1、2、3天肾功能,分析造影剂对冠状动脉介入术患者肾功能的影响,Logistic多因素回归分析影响CIN发生的危险因素。结果236例患者中,男性184例,女性52例,平均年龄(64.6±11.5)岁,发生CIN46例,发病率为19.5%;CIN组中原有肾功能不全者(基线Ccr<60ml/min)达6/46,心功能不全者达19/46,同非CIN组比较有统计学意义(P<0.01)。平均造影剂剂量CIN组为328±166ml,非CIN组为248±124ml,两组比较差异有统计学意义(P<0.01);Logistic逐步回归分析显示,原有肾功能不全(基线Ccr<60ml/min)、造影剂的剂量、LVEF<40%是CIN的独立危险因素。结论CIN在STEMI患者直接PCI后发病率较高,原有肾功能不全、造影剂的剂量、LVEF<40%是CIN的独立危险因素。
Objective To analyse the effect of the low osmolar nonionic contrast medium on renal function in patients undergoing primary percutaneous coronary interventions.To study the incidence and risk factors of contrast-induced nephropathy （ CIN ）. Methods 236 patients with acute ST segment elevation myocardial infarction （STEMI） undergoing primary coronary interventions were enrolled from Oct 2004 to Mar 2007. All patients received low-osmolality nonionic contrast agent. To measure serum creatinine concentration （Cr） at baseline and each day for the following three days. Multivariate predictors of contrast-induce nephropathy determined using logistic regression. Results Among the 236 patients, 184 were males and 52 females. The average age was （64.6±11.5） years. CIN Occurred in 46 patients and the incidence of CIN was 19.5 %. In those who had renal insufficiency or heart failure, the incidence of CIN was significantly higher （P〈0.01）. The average contrast volume was （328±166）ml in CIN group whereas （248±124）ml in non-CIN group,and significant difference was found between the two groups（P〈0.01）. Identified by logistic regression ,pre-existed renal dysfunction （baseline Ccr〈60 ml/min）,the volume of contrast,LVEF 〈40% were independent risk factors of contrast-induced nephropathy. Conclusion Patients submitted to primary percutaneous coronary interventions （PCIs） are quite often at high risk for contrast-induced nephropathy （CIN）, preexisted renal dysfunction,the volume ofcontrast,LVEF〈40% were independent risk factors of CIN.
出处
《中国现代医药杂志》
2007年第9期20-22,共3页
Modern Medicine Journal of China
关键词
直接PCI
造影剂肾病
ST段抬高性心肌梗死
Primary percutaneous Coronary interventions Contrast-induced nephropathy ST Segment elevation myocardial infarction
