静脉水化联合前列地尔对冠心病合并2型糖尿病介入治疗术后对早期对比剂肾病的临床研究

摘要

Objective:To explore the clinical effect of combination therapy of hemoperfusion and alprostadil on early contrast-induced nephropathy in patients with coronary heart disease and type 2 diabetes after percutaneous coronary intervention.Method: 116 patients with CHD and type 2 diabetes verified by clinical features were investigated consecutively and randomly divided into routine therapy group(hemoperfusion therapy, n=58) and combination therapy group(combination therapy of hemoperfusion and alprostadil, n=58) in accordance with the random numbers. Isotonic saline solution 1.0-1.5 mL/(h·kg) was used in routine therapy group from 12 h before PCI to 72 h after PCI. On the base of routine therapy hemoperfusion alprostadil (once 10 μg, qd) was used in combination therapy group from 24 h before PCI to 72 h after PCI. Regular therapy drugs were adopted in the two groups.Result: The level of Scr, Cys C, and β2-MG were significantly lower in combination therapy group than those in routine therapy group. In contrast to routine therapy group, the incidence of CIN in combination therapy group was significantly less (P<0.05).Conclusion: Combined therapy of hemoperfusion and alprostadil in patients with CHD and type 2 diabetes after PCI can reduce the risk of CIN.%目的：探讨经皮冠状动脉介入治疗（PCI）术前至术后联合应用静脉水化和前列地尔对冠心病合并2型糖尿病患者PCI术后预防早期对比剂损害的意义。方法：入选行PCI的冠心病合并2型糖尿病患者116例，按随机数字表法分为常规治疗组58例（静脉水化治疗）和联合治疗组58例（静脉水化联合前列地尔治疗）。两组均给予常规治疗，常规治疗组患者在术前12 h至术后24 h按1.0~1.5 mL/（h·kg）给予等渗盐水持续静脉滴注；联合治疗组在应用静脉水化基础上PCI术前1天使用前列地尔注射液10μg+氯化钠注射液100 mL静脉滴注，qd，连用4 d。对两组患者肾功能指标进行分析。结果：联合治疗组术后72 h的血Scr、Cys C及β2-mG浓度较常规组比较差异有统计学意义（P<0.05）。常规治疗组CIN发生率（9例，15.5%）显著高于联合治疗组（2例，3.4%），比较差异有统计学意义（P<0.05）。两组患者均未见不良反应。结论：冠心病合并2型糖尿病接受PCI术的患者，在常规静脉水化基础上加用前列地尔可显著降低CIN的发生率，且安全性较好。