摘要
在院内发生的急性肾损伤中,对比剂导致的急性肾损伤扮演着重要角色,它可以导致延长住院时间,增加患病率、死亡率和医疗花费,然而目前只有术前水化作为普遍的预防措施。造影剂肾病是影像学检查的重要并发症之一,尤其是慢性肾脏病患者,也是急性肾损伤的常见原因之一。发病机制被认为是氧自由基和高渗胁迫对肾髓质的影响。据报道,在酸性环境中,超氧化物的产生最为活跃。柠檬酸钠是一种可以碱化尿液的药物,研究发现柠檬酸钠同碳酸氢钠均可以有效地降低冠状动脉造影与经皮冠脉介入术患者的造影剂肾病的发病率。研究发现,碱化尿液可以有效地预防造影剂肾病的发生。碳酸氢钠水溶液呈轻度碱性,可提高肾组织局部的p H值至中性或偏碱性而碱化尿液,从而减轻氧自由基和过氧化物对肾脏的损伤,且氧自由基和过氧化物对肾小管的损伤通常是在酸性环境中产生。一些研究显示肾素-血管紧张素-醛固酮系统可能通过导致肾脏异常灌注和其他机制发挥肾毒性作用。托拉塞米作为髓袢利尿剂,可以通过抗醛固酮作用抑制肾素-血管紧张素-醛固酮系统。因此推断托拉塞米可能可以预防急性肾损伤。托拉塞米可能在未来可以作为一种预防对比剂急性肾损伤的手段,可能可以同时合并其他策略例如术前水化或其他肾脏保护措施。水化预防造影剂肾病已经得到公认;但随着医疗人工成本的增加,需寻找出更加简便易行而有效的方法来进行造影剂肾病的预防。大量研究显示,碳酸氢钠及托拉塞米可以增加预防造影剂肾病的作用。目前碳酸氢钠片及托拉塞米片均已上市多年,现希望通过对碳酸氢钠和托拉塞米的既往研究进行综述,以期望未来在这一领域可以更深一步的探讨,增加饮水量辅以口服碳酸氢钠片和托拉塞米片,既可以比静脉注射生理盐水减少人工成本,又可以有效地预防造影剂肾病。
Contrast agents play an important role in acute kidney injuiy in hospital, which can lead to prolonged hospital stays,and increased the morbidity, mortality and medical costs. At present, only preoperative hydration is a common preventive measure. Contrast- induced nephropathy （GIN） is one of the most important complications of imaging studies, especially in patients with chionic kidney disease. It is also one of the most common causes of acute kidney injury. The pathogenesis is believed to be the effect of oxygen free radicals and hypertonic stress on the renal medulla. It is reported that superoxide generation is most active in an acid environment. K/sodiura citrate is a drug that can alkalize urine. It is found that sodium citrate and sodium bicarbonate can effectively reduce coronary artery angiography and percutaneous coronary intervention in patients with the incidence of CIN. It is also found that alkaline urine can effectively prevent the occurrence of CIN. Sodium bicarbonate solution is slightly alkaline, which can improve renal tissue pH value to the neutral or alkaline, alkaline urine,thereby reducing oxygen free radicals and peroxides of kidney damage,and the damage of oxygen free radicals and peroxides of renal tubules is usually produced in the acidic environment. It has been shown that the RAAS may play a nephrotoxic role by causing abnormal kidney perfusion and other mechanisms. Torasemide as a diuretic, can inhibit the RAAS through the anti_aldosterone effect. It is deduced that torasemide may prevent acute kidney injury. Torasemide may be used as a contrast agent for the prevention of acute kidney injury,and be combined with other strategies such as preoperative hydration or other renal protective measures. Hydration prevention of CIN has been recognized. But as the cost of medical labor increases, we need to find a simpler and more effective way to prevent CIN. A large number of studies show that the sodium bicarbonate and torasemide can increase the prevention of CIN. At present, sodium bicarbonate tablets and torasemide tables are in the market for many years,and the study of sodium bicarbonate and torasemide past need a further study in this field in the future. To increase the amount of water with oral sodium bicarbonate tablets and torasemide tables, the labor costs instead of intravenous saline can be reduced,and the contrast nephropathy can be effectively prevented.
出处
《心血管病学进展》
CAS
2018年第2期165-169,共5页
Advances in Cardiovascular Diseases
关键词
造影剂肾病
预防
碳酸氢钠
托拉塞米
Contrast-induced nephropathy
Prevention
Sodium bicarbonate
Torasemide
