经皮冠状动脉介入治疗并发对比剂肾病的临床回顾分析

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1、经皮冠状动脉介入治疗并发对比剂肾病的临床回顾分析全军心血管病研究所沈阳军区总医院心内科赵昕韩雅玲王效增王守力荆全民上海2009.09.27在给对比剂后48小时内，血清肌酐会升高，并在5天内达峰值若肌酐数值在给对比剂后48小时内比基线值升高大于25%或升高大于0.5mg/dl研究发现，给予造影剂后，约60%病人肌酐水平在24小时内升高，90%在72小时内升高；造影后的4－5天达峰值，10天后回归正常水平Marenzi等人发现在CIN病人中，血清肌酐峰值是在术后第2天发生的Harjai等人建议，术后1.6—1.9天为随访肾功能的最佳时间延迟肾病造影剂肾病的

2、定义相关国际学会和临床指南中均已涉及对比剂的合理应用与对比剂肾病的预防策略ACC/SCA&I2001ClinicalExpertConsensusDocumentonCardiacCatheterizationLaboratoryStandardsACC/AHA/SCA&I2005GuidelineUpdateforPercutaneousCoronaryInterventionACC/AHA2005GuidelinesfortheManagementofPatientswithPeripheralArterialDiseaseACR2002ACRP

3、racticeGuidelinefortheUseofIntravascularContrastMedia2003PracticeGuidelineforthePerformanceofDiagnosticArteriographyinAdultsESUR2005GuidelinesonContrastMediaFrenchSocietyofRadiology2004Préventiondel’insuffisancerénaleinduiteparlesproduitsdecontrasteiodés2005Produitsdecontrasteio

4、désetdiabèteGermanCardiacSociety2005ArbeitsanweisungimHKLNKF2005K/DOQIClinicalPracticeGuidelinesforCardiovascularDiseaseinDialysisPatientsJAMA.2006;295(23):2765-2779.RiskFactorsforContrast-InducedNephropathyPatientRelatedChronickidneydiseaseDiabetesmellitusUrgent/electiveprocedu

5、reIntra-aorticballoonpumpCongestiveheartfailureAgeHypertensionLowhematocritHypotensionNotPatientRelatedContrastpropertiesHighosmolarcontrastIoniccontrastContrastviscosityContrastvolume造影剂肾病的危险因子沈阳军区总医院临床资料回顾Toevaluationtheimpactofcontrastmediaonrenalfunctioninpatientswithcoronar

6、yarteryangiographyorPCIandinvestigatetheriskfactorsofCINandtheeffectsofCINonclinicalprognosisinpatientsduringPCI入选标准Oct1998toDec200810305patientswithPCIorcoronaryarteryangiographyofcompletefollow-updatawereadmitted27to92years（65±12years）Tobeusedtheiso-osmia（iodixanol）orthelow-os

7、mia（iopromide）nonioniccontrastmedium研究方法Serumcreatinineconcentration（SCr）wasmeasuredatbaselineandonthelst，2ndand3rddaysAllSCranalyseswereperformedatShenyangGeneralHospitalToobservemajoradversecardiacevents（MACE）duringhospitalizationToanalyzedtheincidenceoftheriskfactorsofCINretr

8、ospectively研究结果P=0.001P=0.011P=0.022Morbidity平均