摘要
目的探讨重度肾功能不全患者行“零对比剂”经皮冠状动脉介入治疗(PCI)的安全性及有效性。方法对2018年1月至2019年12月上海市普陀区中心医院收治的16例重度肾功能不全[估算的肾小球滤过率(eGFR)<30 ml/(min·1.73 m^(2))]的心绞痛或非ST段抬高型心肌梗死患者在血管内超声(IVUS)指导下行“零对比剂”PCI的临床资料进行回顾性分析。结果16例重度肾功能不全患者的eGFR为(21.4±6.8)ml/(min·1.73 m^(2)),使用对比剂(25.0±3.8)ml以确定冠状动脉病变,于IVUS指导下行“零对比剂”PCI,术中支架定位确切,扩张满意,未出现夹层,最终所有患者心肌梗死溶栓治疗试验血流分级为Ⅲ级。16例重度肾功能不全患者PCI术后24 h eGFR、肌酐、肌红蛋白、肌酸激酶同工酶及心肌肌钙蛋白I与术前相比,差异均无统计学意义(均P>0.05);住院期间无再次心肌梗死、心绞痛等症状发生。3个月随访,无不良心血管事件发生。结论重度肾功能不全患者经IVUS指导行“零对比剂”PCI是安全有效的。
Objective In this study,we discuss the safety and efficacy for percutaneous coronary intervention(PCI)without contrast agent in severe renal failure patient.Methods 16 patients for angina pectoris or NSTEMI with severe renal failure[eGFR<30 ml/(min·1.73 m^(2))]were admitted to our hospital from January 2018 to December 2019.The clinical data of PCI with zero contrast under the guidance of IVUS were analyzed retrospectively.Results 16 patients with severe renal failure[eGFR(21.4±6.8)ml/(min·1.73 m^(2))],used the minimum dose of isotonic contrast agent(25.0±3.8)ml to identify coronary lesions.PCI without contrast was successfully performed in all patients under the guidance of IVUS.During the operation,the stent location was accurate,the expansion was satisfactory,and there was no dissection.Finally,TIMI blood fl ow was gradeⅢafter operation.There were no signifi cant diff erences for 16 patients in terms of the levels of their eGFR,creatinine,enzymes in 24 h after PCI than before(all P>0.05);There was no reinfarction and angina pectoris during hospitalization.There was no cardiac event during the three-month follow-up.Conclusions PCI with zero contrast guided by IVUS is safe and eff ective in patients with severe renal failure.
作者
胡文瑛
严鹏勇
王睿
王超凡
金惠根
刘宗军
汪志华
HU Wen-ying;YAN Peng-yong;WANG Rui;WANG Chao-fan;JIN Hui-gen;LIU Zong-jun;WANG Zhi-hua(Department of Cardiology,Putuo District Central Hospital,Shanghai 200062,China)
出处
《中国介入心脏病学杂志》
2021年第7期371-374,共4页
Chinese Journal of Interventional Cardiology
基金
上海市普陀区卫生健康系统临床医学优势学科(2019ysxk01)。
关键词
经皮冠状动脉介入治疗
对比剂肾病
重度肾功能不全
血管内超声
Percutaneous coronary intervention
Contrast-induced nephropathy
Severe renal failure
Intravascular ultrasound
