目的：评估严重肾功能不全患者冠状动脉介入治疗后行床旁血液滤过对对比剂肾病（CIN）的发生率及临床疗效的影响。方法回顾性分析本中心30例因严重肾功能不全行冠状动脉介入治疗的患者，术后即刻给予床旁血液滤过，收集临床资料，检测患者术前和术后24 h、72 h、1周的肌酸酐（肌酐）值，并根据Cockcroft和Gault equation公式计算肌酐清除率（CrCl），评估术后CIN发生率，以及短期临床疗效。结果30例患者平均年龄（729±8.7）岁，其中男21例（70.0%）。慢性肾疾病分期（CKD）3期3例（10.0%），CKD 4期20例（66.7%），CKD 5期7例（23.3%）；平均血液滤过持续时间（7.5±4.1）h，术前和术后24 h、72 h、1周血肌酐值分别为（498.7±143.7）、（353.2±128.0）、（450.0±132.2）、（488.0±145.7）μmol/L，CrCl值分别为（20.3±10.2）、（36.5±14.3）、（28.3±10.4）、（21.0±10.3）ml/min，患者术后未出现CIN。平均随访（3.1±2.6）个月，30例患者未见新发心血管事件，且未见新发需依赖血液透析患者。结论对于严重肾功能不全的患者，介入治疗后行床旁血液滤过可以减少对比剂肾病的发生，是一个可供选择的减少对比剂肾病的预防措施。%Objective To assess the value of hemofiltration in the prevention of contrast induced nephropathy(CIN) post percutaneous coronary intervention(PCI) in severe chronic kidney disease stages(CKD) patients. Methods We evaluated 30 CKD patients who underwent PCI followed by bedside hemofiltration. We measured serum creatinine levels before PCI, 24 hours, 72 hours, and one week after PCI, and calculated creatinine clearance(CrCl) according to Cockcroft and Gault equation.We observed the incidence of CIN, and the short term clinical efficacy of hemofiltralion. Results The average age of the 30 patients was (72.87 ± 8.71) years old, with 21 (70%) male patients. The stages of CKD among the patients included CKD 3 (3 patients, 10%), CKD 4 (20 patients, 66.7%) and CKD 5 (7 patients, 23.3%). The average duration of hemofiltration was (7.5±4.1) hours. Serum creatinine before PCI, 24 hours, 72 hours and 1 week after PCI was (498.7±143.7)μmol/L, (353.2±128.0)μmol/L, (450.0±132.2)μmol/L, (488.0±145.7)μmol/L respectively,and CrCl was (20.3±10.2) ml/min, (36.5±14.3) ml/min, (28.3±10.4) ml/min, (21.0±10.3) ml/min respectively. There was no CIN. Mean follow-up was (3.1 ± 2.6) months. There was no new cardiovascular events, and no new patients need to rely on long term hemodialysis. Conclusions For patients with severe renal insufficiency, hemofiltration may reduce the incidence of CIN, It is an alternative preventive measures to prevent CIN.
展开▼
