中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (08): 388-391.doi: 10.3969/j.issn.1671-4091.2016.08.002

• 临床研究 • 上一篇    下一篇

老年慢性肾衰竭患者对比剂所致急性损伤的预防性血液净化研究

李湛1, 毛永辉1,赵班1, 王松岚1 ,宋尽染2, 孙福成2   

  1. 1. 北京医院国家老年医学中心 肾脏内科
    2. 北京医院国家老年医学中心 心脏内科
  • 收稿日期:2016-04-05 修回日期:2016-06-13 出版日期:2016-08-12 发布日期:2016-07-12
  • 通讯作者: 毛永辉：mmdn2009@163.com E-mail:mmdn2009@163.com
  • 基金资助:

    ：首都临床特色应用研究与成果推广课题编号：Z151100004015083；北京医院院级课题编号：BJ-2012-72

Prophylactic blood purification for contrast-induced acute kidney injury in elderly patient with chronic renal failure

  • Received:2016-04-05 Revised:2016-06-13 Online:2016-08-12 Published:2016-07-12

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摘要： 目的  了解间断静静脉血液滤过(intermittent venovenous hemofiltation，IVVH)预防老年慢性肾衰竭患者对比剂所致急性肾损伤(contrast-induced acute kidney injury, CI-AKI)的应用现状，探讨IVVH 对老年慢性肾衰竭患者CI-AKI 的预防作用。方法回顾性分析2014 年6 月～2015 年12月于北京医院心内科行冠状动脉造影检查和/或经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的39 例老年(≥60 岁)慢性肾衰竭患者相关临床资料。按照PCI 术后是否行预防性血液净化措施，将患者分为IVVH 组和非IVVH 组，比较组间对比剂所致急性肾损伤发生率及相关临床资料。结果39 例老年慢性肾衰竭患者，年龄(74.03±7.65)岁；IVVH 组18 例，非IVVH 组21 例。18 例PCI 术后行IVVH 慢性肾衰竭患者：高血压肾病8 例、糖尿病肾病3 例、缺血性肾病2 例、其他肾脏病5 例；术前血肌酐(188.83 ± 76.68)mmol/L，术前肾小球滤过率评估(estimated glomerular filtration rate, eGFR)(30.89±12.38)ml/(min·1.73m2)，含碘对比剂用量(176.67±69.11)ml；IVVH 参数：血流速(155.56±9.84)ml/min，血滤置换液流速(29.73±6.42)ml/(kg·h)，每次超滤量386.72±265.75ml。IVVH 组和非IVVH 组CI-AKI 发生率分别为5.56%、42.86%，组间存在统计学差异(χ2=5.252，P=0.022,)。结论PCI术后行IVVH可能是降低老年慢性肾衰竭患者CI-AKI 发生的有效措施。

关键词: 慢性肾衰竭, 对比剂肾病, 间断静静脉血液滤过, 预防

Abstract: Objective To investigate the effect of intermittent venovenous hemofiltration (IVVH) for the prevention of contrast-induced acute kidney injury (CI-AKI) in elderly patients with chronic renal failure (CRF) as well as the current situation about this clinical issue. Methods A total of 39 elderly (≥60 years old) CRF patients treated with coronary angiography and /or percutaneous coronary intervention (PCI) in Beijing Hospital during the period from Jun. 2014 to Dec. 2015 were retrospectively studied. There were divided into IVVH group (with preventive IVVH after PCI) and non-IVVH group (without preventive IVVH after PCI). The prevalence of CI-AKI and its related clinical data were compared between the two groups. Results The average age was 74.03±7.65 years old in the 39 elderly CRF patients, of whom 18 were in the IVVH group and 21 in the non-IVVH group. In the 18 patients in IVVH group, the primary diseases for CRF were hypertensive nephropathy (n=8), diabetic nephropathy (n=3), ischemic nephropathy (n=2), and other renal diseases (n=5); before PCI, serum cretinine was 188.83 ± 76.68 mmol/l, and eGFR was 30.89±12.38 ml/(min·1.73m2); the average iodinated contrast agent used was 176.67±69.11ml; the parameters of IVVH used were blood flow rate 155.56±9.84 ml/min, hemofiltration fluid replacement rate 29.73±6.42 ml/(kg·h), and ultrafiltration volume 386.72 ±265.75 ml/time. The prevalence of CI-AKI was 5.56% in IVVH group and was 42.86% in non- IVVH group (χ2=5.252, P=0.022). Conclusions Preventive IVVH after PCI is probably an effective measure to reduce the prevalence of CI-AKI in elderly patients with chronic renal failure.

Key words: chronic renal failure, contrast-induced acute kidney injury,  Intermittent venovenous hemofiltration, prevention