摘要
目的:了解急性冠脉综合征(acutecoronary syndrome,ACS)患者经皮冠脉介入(percutaneous coronary intervertion,PCI)前的肾功能状态及术后改变。探讨肾功能恶化的易患因素及其对患者预后的影响。方法:回顾性分析2005年6-12月在我科接受PCI治疗的ACS患者101例,了解其术前的肾功能水平及术后改变,术后随访6～18个月。结果:PCI术前以血肌酐标准衡量肾功能,4.8%(5例)患者存在轻度的肾功能不全,以内生肌酐清除率(Ccr)作为标准时,却高达69.3%(70例)。PCI术后约18.8%(19例)的患者肾功能恶化而导致造影剂肾病(contrast media induced nephropathy,CIN)。3例出现在术前肾功能正常组,16例出现在术前肾功能不全组。合并慢性肾病、心力衰竭、高龄、接受大剂量造影剂、急诊PCI的患者发生率高。CIN组患者的平均住院时间、主要不良事件发生率、总死亡率均显著高于非CIN组(P<0.05)。结论:Ccr是准确评估肾功能的合理指标。肾功能不全在老年ACS患者中十分常见。术前肾功能受损、慢性肾病、心力衰竭、高龄、大剂量造影剂、急诊PCI是PCI术后发生CIN的易患因素。CIN的发生显著延长患者的住院时间、增加不良事件和死亡。
Objective To understand the baseline renal functional in patients With acute coronary syndrome （ACS） and its alterations after pereutaneous coronary intervention （PCI） and to explore the factors of deteriorating renal function and their effects on the prognosis of patients. Methods The data on 101 patients with ACS who received PCI from June 2005 to December 2005 were retrospectively analyzed to understand patients＇ baseline renal function and their alterations after the procedure. All the patients were followed 6 to 18 months. Results 5 patients （4.8%） had mild renal dysfunction before PCI using Scr as the detective index whereas 70 （69.3%） demonstrated renal dysfunction using Ccr as the index. Renal function deteriorated in 19 patients （18.8%） after PCI resulting in contrast-induced nephropathy （CIN）, 3 of them had normal baseline renal function and 16 were abnormal in baseline renal function. The incidence of CIN was higher in those with chronic kidney disease or heart failure, old age, receiving high dose of contrast media or urgent PCI. Average hospital stay was longer and the incidences of major adverse events and overall mortality were higher in CIN group than in non-CIN group （P 〈 0.05）. Conclusions Ccr is an appropriate index for accurately estimating renal function. Renal dysfunction is common in .elderly patients with ACS. Abnormal baseline renal function, chronic kidney disease, heart failure, old age, use of high dose of contrast media, and urgent PCI are the predisposing factors for developing CIN after PCI. CIN can significantly prolong length of hospital stay and increase the incidences of adverse events and mortality.
出处
《实用医学杂志》
CAS
2008年第10期1723-1726,共4页
The Journal of Practical Medicine
关键词
冠状动脉疾病
血管成形术
经腔
经皮冠状动脉
肾功能
造影剂肾病
Coronary disease Angioplasty, transluminal, percutaneous coronary Renal function Contrastinduced nephropathy
