中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 566-569.doi: 10.3969/j.issn.1671-4091.2018.08.015

• 护理研究 • 上一篇    下一篇

水化及规范护理对肾动脉狭窄介入治疗致对比剂肾病的预防作用

王玉1,叶宝珠1,王国勤1,王艳艳1,顾惠英1,李琳1,程虹1   

  1. 1.. 首都医科大学附属北京安贞医院肾内科
  • 收稿日期:2018-04-03 修回日期:2018-05-31 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 程虹 drchengh@163.com E-mail:fumotouxi@sina.com

The effects of adequate hydration and standardized nursing on the prevention of contrast-induced nephropathy after interventional therapy of renal artery stenosis

  • Received:2018-04-03 Revised:2018-05-31 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的  探讨肾动脉狭窄(renal artery stenosis，RAS)介入治疗前后充分水化对预防对比剂肾病(contrast-induced nephropathy，CIN)的效果及护理的作用。方法  选取2012 年2 月～2017 年12月住院做经皮经腔肾血管成形及血管支架术(percutaneous transluminal renal angioplasty and stent placement，PTRA+S)治疗的动脉粥样硬化性RAS 患者50 例，全部患者在介入前后均接受了充分水化及规范化护理，后者包括术前CIN 风险评估，术前、后心理护理，静脉通路建立及维护，床上排尿训练及尿量监测，术后病情观察及记录。结果  与低危组(20 例)比较，中高危组(中危28 例，高危2 例)患者的年龄大，基线血清肌酐(serum creatinine, SCr)值高，估算肾小球滤过率(estimate glomerular filtration rate，eGFR) 值低，碘对比剂用量多(P 值分别为＜0.001, ＜0.001, ＜0.001, 0.009)，提示其发生CIN 风险较低危组显著高。但是，在接受充分水化及规范化护理后，中高危组与低危组一样，均无CIN发生。结论充分水化能有效预防PTRA+S 治疗的CIN 发生，规范化护理对保证水化质量及效果具有重要作用。

关键词: 肾动脉狭窄, 介入治疗, 经皮经腔肾血管成形术, 对比剂肾病, 水化

Abstract: 【Abstract】Objective To investigate the effects of adequate hydration and standardized nursing on the prevention of contrast-induced nephropathy (CIN) in patients after interventional therapy of renal artery stenosis (RAS). Methods A total 50 hospitalized patients with atherosclerotic RAS treated with percutaneous transluminal renal angioplasty and stent placement (PTRA+S) in the period from February 2012 to December 2017 were enrolled in this study. Before and after the interventional therapy, patients received adequate hydration and standardized nursing, including preoperative CIN risk assessment, pre- and postoperative psychological care, establishment and maintenance of venous access, bed urination training and urine output monitoring, and observation of postoperative condition. Results Compared with the low-risk group (20 cases), the patients in the moderate and high-risk group (28 and 2 cases, respectively) were older, had higher levels of baseline serum creatinine (SCr), lower levels of estimate of glomerular filtration rate (eGFR), and applied larger doses of contrast agent (P＜0.01), suggesting that CIN occurs more likely in these patients. However, after receiving adequate hydration and standardized nursing, no patient developed CIN in the moderate and high-risk group just as in the low- risk group. Conclusion Adequate hydration can effectively prevent CIN after PTRA+S therapy, and standardized nursing plays an important role in ensuring the quality and effect of hydration.

Key words: Renal artery stenosis, Interventional therapy,  Percutaneous transluminal renal angioplasty, Contrast-induced nephropathy, Hydration