《中国康复理论与实践》

《中国康复理论与实践》 ›› 2008, Vol. 14 ›› Issue (04): 323-325.

• 专题 • 上一篇    下一篇

合并慢性肾功能不全老年冠心病患者介入治疗围手术期水化疗法的可行性分析

齐冠鸣; 杨庭树; 韩宝石; 张华巍; 王舒   

  1. 解放军总医院心血管内科,北京市 100853
  • 收稿日期:2008-01-14 出版日期:2008-04-01 发布日期:2008-04-01

Feasibility of Hydration Treatment During Perioperative Period of Interventional Therapy for Gerontic Patients with Coronary Heart Disease Complicated by Chronic Renal Insufficiency

QI Guan-ming, YANG Ting-shu, HAN Bao-shi, et al   

  1. The Department of Cardiology, the General Hospital of PLA, Beijing 100853, China
  • Received:2008-01-14 Published:2008-04-01 Online:2008-04-01

PDF (PC)

被引次数

31

摘要： 目的探讨慢性肾功能不全老年冠心病患者行冠状动脉介入治疗时,围手术期水化处理保护肾脏功能的安全性及疗效。方法回顾性分析168例合并慢性肾功能不全的老年(≥60岁)冠心病患者介入治疗围手术期水化治疗与其肾功能的相关性。168例患者分为3组:A组行选择性冠状动脉造影术(SCA),围手术期无特殊处理;B组行SCA,围手术期给予碱化+水化治疗;C组行SCA+冠状动脉内介入治疗(PCI),围手术期给予碱化+水化治疗。结果168例患者均成功完成SCA或PCI术,30例发生造影剂相关性肾病(CAN),其中A组、B组和C组的CAN发生率分别为27.4%、7.5%和15.2%,住院期间无1例需要透析治疗。患者原发伴随疾病及个人特征对CAN发生率也有影响,高脂血症患者较血脂正常患者、糖尿病患者较非糖尿病患者、肾动脉狭窄患者较非肾动脉狭窄患者、心功能Ⅲ～Ⅳ级患者较Ⅰ～Ⅱ级患者,CAN发生率显著增高(P<0.001)。结论合并慢性肾功能不全老年冠心病患者行冠状动脉介入诊治时,围手术期给予水化治疗加NaHCO3碱化处理可较好地保护肾脏功能,提高介入手术耐受性,改善预后。

关键词: 慢性肾功能不全, 冠状动脉疾病, 老年患者, 介入治疗, 造影剂相关性肾病, 水化, 碳酸氢钠, 围手术期

Abstract: Objective To investigate the safety and efficacy of protective measures(hydration treatment)during perioperative period of interventional therapy for renal function of gerontic patients with coronary artery disease(CAD)complicated by chronic renal insufficiency(CRI).Methods The relation between hydration therapies and the renal function of 168 CAD patients(≥60 years old)complicated by CRI were analyzed.These patients were divided into three groups:in the group A,patients underwent selective coronary angiography(SCA)with conventional treatment during interventional perioperative period(IPP);in the group B,patients underwent SCA and treated with the NaCl plus low dose NaHCO3 during IPP;in the group C,patients underwent percutaneous coronary intervention(PCI),and meanwhile treated with the same dose NaCl and NaHCO3 as the group B during IPP.Results Coronary interventions were successful in all 168 patients.Contrast medium associated nephropathy(CAN)was found in 30 patients,and incidences of the CAN were 17(27.4%)in the group A,3(7.5%)in the group B and 10(15.2%)in the group C,respectively.The accompanying diseases and characteristics of the patients also effected the incidence of CAN:the CAN incidence of patients with hyperlipidemia was significantly higher than that with normal cholesterol(P<0.001);patients with diabetes was significantly higher than that with normal serum glucose(P<0.001);patients with stenosis of renal artery was significantly higher than that with normal renal artery(P<0.001);patients with heart failure(grade Ⅲ～Ⅳ)was significantly higher than that with the grade Ⅰ～Ⅱ(P<0.001).Conclusion The hydration treatment with the NaCl plus low dose NaHCO3 during IPP can protect renal function and increase tolerance for gernotic CAD patients complicated by CRI during IPP,and improve prognosis.

Key words: chronic renal insufficiency, coronary artery disease, gerontic patient, interventional therapy, contrast medium associated nephropathy, hydration, sodium bicarbonate, perioperative period