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冠状动脉造影术后发生对比剂肾病的危险因素分析及防治措施探讨 被引量:7

Risk factors of contrast-induced nephropathy after coronary angiography and the countermeasures
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摘要 目的探讨冠状动脉造影术后发生对比剂肾病(contrast induced nephropathy,CIN)的危险因素及其防治措施。方法选择2014年1月至2015年10月于新疆昌吉州人民医院行冠状动脉造影术的1115例患者为研究对象,所有患者均按照标准法行冠状动脉造影术,术中使用对比剂为低渗非离子型对比剂碘佛醇,术前检测血肌酐(SCr),术后24~72h复查SCr,根据患者手术前后SCr水平变化分为CIN组83例和非CIN组1032例,2组患者使用相同方法进行水化、碱化。统计2组患者年龄、性别、吸烟、对比剂剂量以及糖尿病、慢性肾脏病、高血压、高脂血症、心功能不全方面的资料,数据采用SPSS20.0统计软件进行分析,并进行多因素Logistic回归分析,指出发生CIN的危险因素,并提出防治措施。结果1115例接受冠状动脉造影术的患者中有83例发生CIN,CIN的发生率为7.44%。CIN组患者在年龄、糖尿病、慢性肾脏病、对比剂剂量方面与非CIN组比较,差异有统计学意义(P〈0.01);2组在性别、吸烟、高血压、高血脂、心功能不全方面差异无统计学意义(P〉0.01)。Logistic回归分析显示:高龄(OR=1.005,95%CI:1.005~1.048,P:0.002),慢性肾脏病(OR=5.977,95%CI:4.652~6.054,P:0.000),糖尿病(OR=2.077,95%CI:1.214~3.555,P=0.008),对比剂剂量(OR=2.020,95%CI:1.2403.293,P=0.005),性别(OR=0.858,95%CI:0.599~1.229,P=0.403),吸烟(OR=0.858,95%CI:0.558~1.053,P=0.101),高血压(OR=1.141,95%CI:0.825~1.577,P=0.426),高脂血症(OR=1.066,95%CI:0.884~1.287,P=0.502),心功能不全(OR=0.789,95%CI:0.4941.261,P=0.322)。结论高龄、慢性肾脏病、糖尿病、对比剂剂量是CIN发生的4个独立危险因素,其中慢性肾脏病是最强预测因子。加强冠状动脉造影术患者的术前评估,术前、术中、术后积极采取预防措施,尤其是水化、碱化疗法,是目前防治CIN的有效措施。 Objective To investigate risk factors of contrast-induced nephropathy (CIN) in pa- tients with coronary heart disease undergoing coronary angiography, and provide the basis for preven- ting and improving the prognosis. Methods 1115 patients undergoing coronary angiography were en- rolled in this study, and divided into CIN group and non-CIN group according to changes in serum cre- atinine levels within 24 h-72 h after percutaneous coronary intervention. Both groups were given lover- sol and underwent hydration. Data on age, gender, smoking, diabetes, contrast agent dose, chronic kidney disease, hypertension, hyperlipoidemia, heart failure etc, and risk factors of CIN were ana- lyzed by Logistic regression analysis. Results Eighty-three cases of CIN were found in 1115 patients with coronary heart disease who underwent coronary arteriography with the incidence of CIN being 7. 44%. Multivariate Logistic regression analysis showed that advanced age (OR = 1. 005, 95% CI: 1. 005 - 1. 048, P = 0. 002), chronic kidney disease (OR = 5. 977, 95% CI: 4. 652 - 6. 054, P = 0. 000), diabetes (OR= 2. 077, 95% CI: 1. 214 - 3. 555, P = 0. 008), and contrast agent dose (OR=2. 020, 95% CI: 1. 240 - 3. 293, P = 0. 005) were the independent risk factors for CIN. For gender, OR = 0. 858, 95 % Ch 0. 599- 1. 229, P = 0. 403; smoking, OR = 0. 858, 95% CI: 0. 558- 1. 053, P =0. 101; hypertension, OR= 1. 141, 95% CI: 0. 825- 1. 577, P = 0. 426; hyperlipoidemia, OR = 1. 066, 95% CI: 0. 884 - 1. 287, P = 0. 502; and heart failure, OR = 0. 789, 95% CI: 0. 494 - 1. 261, P = 0. 322. Conclusions Advanced age, chronic kidney disease, diabetes and contrast agent dose were the independent risk factors for CIN in patients with coronary heart disease after percutaneous coro- nary intervention. Especially, rigorous preoperative preparation and hydration were important preven- tion strategies for CIN.
出处 《临床肾脏病杂志》 2016年第5期281-285,共5页 Journal Of Clinical Nephrology
基金 新疆昌吉州科学研究和技术开发计划项目(NO.2014S01-09)
关键词 冠状动脉造影术 对比剂肾病 危险因素 Coronary arteriography Contrast-induced nephropathy Risk factors
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