目的 探讨低渗非离子造影剂对糖尿病患者行介入诊疗术治疗前后对肾功能的影响,了解造影剂肾病(CIN)发生的危险因素.方法 回顾分析接受下肢血管介入诊疗手术的30例糖尿病住院患者使用造影剂前后血清肌酐的变化.30例糖尿病住院患者均使用等渗非离子造影剂,剂量100～200ml,接受水化(静脉或口服水化).结果 造影剂使用前肾功能正常者28例,肾功能异常者2例；造影剂使用后无CIN患者发生.结论 慢性肾功能不全、糖尿病、肾毒性药物、血管内有效血容量减少、使用ACEI和造影剂种类是发生CIN的危险因素,但如在介入前给予肾功能不全患者危险因素充分评估和给予积极干预,对高危患者严格掌握造影的适应证,同时造影时给予非离子型造影剂中等剂量100～150ml/每次,术后充分水化,是安全的.%Objective To analyse the of low-osmolality nonionic contrast media on renal function in patients with diabetes mellitus undergoing interventional,and to study the risk factors of contrast-induced nephropathy (CIN).Methods The data of 30 cases of hospitalized diabetic patients,who underwent contrast media in lower limb vascular interventional,were retrospectively analyzed.Changes of serum creatinine (SCr) before and after treatment were compared.Results (1)30 diabetic patients received low-osmolality nonionic contrast agent.The contrast volume was 100-200ml.All patients received hydration therapy (intravenous or oral) ; (2) 28 patients with normal renal function and two patients with abnormal renal function before using contrast agent,none experienced CIN.Conclusion Patients with chronic renal insufficiency,diabetes,renal toxicity of drugs or intravascular blood volume reduction would be the risk factors of CIN.The elderly diabetes patients with contrast agent did not experience CIN.It may be associated with less samples and preoperative intervention treatment,general management on diabetes.If we evaluate fully the risk factors and give positive intervention to the renal insufficiency patients before intervention,and master the indication of angiography.In highrisk patients,nonionic contrast medium with proper dosage and adequate hydration could make it safe.
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