中国血液净化

›› 2004, Vol. 3 ›› Issue (1): 21-23.

• 论著 • 上一篇    下一篇

血液透析滤过预防造影剂肾病的临床观察

何朝生 梁馨苓 史 伟 刘双信 叶智明 梁永正 陈纪言   

  1. 510080 广州， 广东省人民医院肾内科(何朝生，梁馨苓，史伟，刘双信，叶智明，梁永正)，心血管病研究所(陈纪言)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-01-19 发布日期:2004-01-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-01-19 Published:2004-01-19

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摘要：

目的 探讨在肾功能不全的患者中造影后立即给予预防性血液透析滤过(Hemodiafiltration HDF) 能否预防造影剂肾病的发生。 方法 对我院1995～2003年56例有肾功能不全的患者使用造影剂（碘普罗胺）行冠状动脉造影后进行一个回顾性的分析。56例患者分为两组，其中一组（30例）给予常规治疗，另一组（26例）于造影后立即给予12～16小时连续性静静脉血液透析滤过(CVVHDF)单次治疗，分析此两组患者造影后的肾功能的变化、需要暂时肾替代治疗的频率、造影临床相关事件（肺水肿、心肌梗死、休克）的发生率以及患者的死亡率。 结果 常规治疗组造影剂肾病发生率14/30(47%)，而血液透析滤过组造影剂肾病发生率为 2/26（8％）（P<0.01），常规治疗组需暂时肾替代治疗（血液透析或血液滤过）的发生率为 10/30 (33％)，而血液透析滤过组需暂时肾替代治疗的发生率为 1/26 (4％)(P<0.05)，常规治疗组造影临床相关事件（肺水肿、心肌梗死、休克）的发生率为 14/30(47%)，血液透析滤过组为1/26 (4%)（P<0.01），常规治疗组住院死亡率为 3/30(10%)，而血液透析滤过组住院死亡率为1/26（4％）（P<0.05）。结论 肾功能不全的患者在给予冠状动脉造影后立即给予预防性血液透析滤过可以有效地阻止造影剂对肾功能的损害，并可明显改善患者的预后。

关键词: 血液透析滤过, 预防, 造影剂肾病

Abstract:

Objective To discuss whether radiocontrast nephropathy can be avoided by prophylactic hemodiafiltration immediately after the administration of contrast media in patients with impaired renal function. Methods We retrospectively analyzed 56 patients(1995～2003year in-hospital) with impaired renal function who received contrast medium injection. Patients were assigned to either hemodiafiltion (n = 26) or routine treatment (n = 30) after parenteral low-osmolality contrast media. The renal function、the rate of in-hospital events（pulmonary edema、 myocardial infarction 、stroke）、In-hospital mortality and temporary renal-replacement therapy freguency were observed. Results The incidence of contrast-agent induced nephropathy was 47 percent in the routine treatment group, and 8 percent in the hemodiafiltration treatment group; Temporary renal-replacement therapy (hemodialysis or hemofiltration) was required in 30 percent of the control patients and in 8 percent of the patients in the hemodiafiltration group(P<0.05). The rate of in-hospital events was 4percent in the hemodiafiltration group and 50 percent in the control group (P<0.01). In-hospital mortality was 4 percent in the hemodiafiltration group and 13 percent in the control group (P<0.05). Conclusion In patients with chronic renal failure who are undergoing percutaneous coronary interven-tions, prophylactic hemodiafil-tration therapy appears to be effective in preventing the deterioration of renal function due to contrast-agent-induced nephropathy and it's may improve prognosis effectively.

Key words: Prophylactic, Contrast agent-induced nephropathy

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