摘要
目的探讨老年糖尿病患者预防对比剂肾病(CIN)的方法。方法共入选256例接受冠脉介入治疗的老年糖尿病患者,根据所用对比剂的种类及接受水化治疗与否分为碘普罗胺组(n=85),碘普罗胺联合水化治疗组(n=87)和碘克沙醇组(n=84)。所有入选患者均于术前及术后第3日检测血肌酐水平,观察患者手术前后血肌酐水平的变化情况,研究的主要终点为3组患者术后CIN的发生率。结果 3组患者的术前血肌酐水平、肌酐清除率及术中对比剂用量无明显差异,术后碘普罗胺组、碘普罗胺联合水化治疗组以及碘克沙醇组CIN的发生率分别为18.8%,8.0%和13.1%。联合水化治疗组CIN的发生率明显低于碘普罗胺组患者(P=0.038),而碘克沙醇组与碘普罗胺组间CIN的发生率差异无统计学意义。结论相比于单纯应用等渗对比剂,联合水化治疗在降低老年糖尿病患者CIN发生率方面发挥更重要的作用。因此,对于拟行冠脉介入治疗的老年糖尿病患者,手术前后应进行水化治疗以减少CIN的发生。
Objective To investigate the optimal strategy for preventing contrast medium-induced nephropathy（CIN）in elderly diabetic patients undergoing percutaneous coronary intervention （PCI）.Methods Two hundred and fifty-six consecutive elderly diabetic patients who underwent percutaneous coronary interventions were enrolled.Patients were randomized into iopromide （A,n=85）,iopromide plus hydration therapy （B,n=87）,and iodixanol （C,n=84）group.Serum creatinine （SCr） levels were assessed at baseline and 3 d after the procedure.The primary end point was the incidence of CIN,which was defined as a 25% increase of SCr concentration 48 h after the procedure.Results The amount of contrast medium used,baseline SCr levels,and SCr clearance were not significantly different among the 3 groups.CIN incidence was lower in group B than in group A （8.0% vs 18.8%,P0.05）,and was not significantly different between group B and group C （13.1%）.Conclusion Compared with single use of contrast medium,the combined hydration therapy is extremely important for the prevention of contrast medium-induced nephropathy in the elderly diabetic patients who are scheduled to undergo PCI.
出处
《中华老年多器官疾病杂志》
2010年第2期148-150,共3页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
造影剂
肾病
老年人
糖尿病
contrast agents
nephropathy
elderly
diabetes mellitus
