摘要
目的:探讨中心静脉压(CVP)指导慢性肾脏疾病(CKD)合并冠心病(CHD)患者水化对降低造影剂肾病(CIN)风险的临床效果。方法:选择于我院心内科接受经皮冠状动脉介入治疗(PCI)的CKD合并CHD患者149例作为前瞻性观察研究对象,随机分为CVP组(73例)和对照组(76例)。CVP组根据动态监测CVP的结果每小时精细地调整水化补液速度,对照组的水化补液速度为1ml·kg^(-1)·h^(-1)[左室射血分数(LVEF)<40%的患者为0.5ml·kg^(-1)·h^(-1)]。主要终点事件为CIN的发生率。结果:与对照组相比,CVP组的水化体积显著提高(P<0.05),其他基线特征相似(P>0.05)。CVP组和对照组PCI后CIN的发生率分别为5.5%和11.8%,组间比较差异无统计学意义(P=0.169)。CVP组暴露于造影剂后48h内绝对肌酐(SCr)水平显著低于对照组[(-0.01±0.43)mg/dl∶(0.07±0.31)mg/dl,P=0.005]。在住院期间和手术后90d内,CVP组累积次要不良事件发生率为6.8%,对照组为18.4%,组间比较差异有统计学意义(P=0.034)。结论:CVP指导水化较标准水化方案并不能更好地降低CIN的发生风险。
Objective：This study aimed to explore the hemodynamic index-guided hydration method for patients with coronary heart disease（CHD）and chronic kidney disease（CKD）to reduce the risk of contrast-induced nephropathy（CIN）.Method：This prospective,randomized clinical trial enrolled 149 consecutive patients with CKD and CHD undergoing coronary procedures.These patients were randomly assigned to either central venous pressure（CVP）group（n=73）or the control group（n=76）.In the CVP group,the hydration infusion rate was dynamically adjusted according to CVP level every hour.An intravenous infusion of 0.45% saline at a rate of 1 ml·kg-（-1）·h-（-1）（0.5 ml·kg-（-1）·h-（-1） for patients with LVEF40%）was given to the control group.The primary endpoint was the incidence of CIN.Result：Compared with the control group,the hydration volume of CVP group was significantly increased（P〈0.05）,and other baseline characteristics were similar（P〈0.05）.The incidence of CIN in CVP group and control group were 5.5% and 11.8% respectively,the difference was not statistically significant（P= 0.169）.The absolute SCr levels in the CVP group exposed to contrast medium for 48 hwere significantly lower than those in the control group[（-0.01±0.43）mg/ml vs（0.07±0.31）mg/ml,P=0.005].During the hospital stay and out to 90 days after the procedure,myocardial infarction incidence was much lower in the CVP group than in the control group（6.8% vs 18.4%,P=0.034）.Conclusion：CVP-guided hydration is not able to produce a better risk of CIN than standard hydration regimen.
作者
周锡平
彭永权
ZHOU Xiping;PENG Yongquan(Department of Cardiology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Chin)
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2018年第4期351-355,共5页
Journal of Clinical Cardiology
关键词
水化
中心静脉压
慢性肾脏疾病
冠心病
造影剂肾病
hydration
central venous pressure
chronic kidney disease
coronary heart disease
contrast-in-duced nephropathy
