本文選題：造影劑腎病 + 水化�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:隨著冠脈介入治療技術(shù)的普遍發(fā)展,造影劑在臨床使用的不斷增加,造影劑腎病(contrast-induced nephropathy,CIN)的發(fā)病率也隨之增加,是目前醫(yī)院獲得性急性腎損傷的第三大原因[1]。CIN是碘造影劑在行PCI手術(shù)應(yīng)用后的并發(fā)癥,病死率達(dá)35%。目前臨床上對(duì)于CIN暫無有效的治療措施,術(shù)前對(duì)具有高危風(fēng)險(xiǎn)的患者進(jìn)行篩查評(píng)估,正確地使用并盡量減少造影劑的使用劑量;預(yù)防性水化等干預(yù)措施,早期精確的診療;盡量降低CIN發(fā)生率及危害[2]。臨床上經(jīng)常將血清肌酐(Scr)作為CIN早期檢測指標(biāo)。高齡、心功能不全、貧血、糖尿病、高血壓等現(xiàn)已證實(shí)為CIN危險(xiǎn)因素。隨著社會(huì)經(jīng)濟(jì)的發(fā)展,人類飲食水平的提高,肥胖已成為社會(huì)健康的重要問題,肥胖不僅是冠心病、高血壓、糖尿病重要的危險(xiǎn)因素,肥胖導(dǎo)致腎功能損傷稱肥胖相關(guān)性腎病[3]。體重指數(shù)一直作為肥胖的診斷標(biāo)準(zhǔn),“理想體重”作為保護(hù)因素一直被大眾追捧。肥胖和CIN發(fā)生通過一個(gè)共同的炎癥通路聯(lián)系在一起,肥胖可能與CIN獨(dú)立相關(guān)[4],也有報(bào)道肥胖引起腎小球高濾過可提高腎小管對(duì)鈉的重吸收,對(duì)腎臟的保護(hù)作用可能降低CIN的發(fā)生[4]。目的:本研究將通過對(duì)體重指數(shù)分析和應(yīng)用造影劑48h內(nèi)肌酐值的變化來探討體重指數(shù)與造影劑腎病的關(guān)系。方法:研究對(duì)象選擇從2016年1月至2016年12月于我院行經(jīng)皮冠狀動(dòng)脈介入治療手術(shù)的患者,共352例,其中男性262例,女性90例,平均年齡57.94±9.45歲,平均體重72.80±10.86千克。所有入選患者進(jìn)行臨床資料收集,包括患者一般情況(如體重、身高、年齡、性別等)、既往病史(高血壓、糖尿病、高脂血癥、腎臟疾病)、用藥史、體格檢查等,完善實(shí)驗(yàn)室檢查(包括血常規(guī)、凝血常規(guī)、肝功能、腎功能、電解質(zhì)、血脂、血糖等)、常規(guī)心電圖、胸片及心臟超聲檢查等其他經(jīng)皮冠狀動(dòng)脈介入治療術(shù)的常規(guī)術(shù)前檢查。將入選的患者按體重指數(shù)分為兩組,BMI24組;BMI在≥24組。記錄基本特征和常規(guī)檢查并給于抗凝、抗血小板聚集等常規(guī)藥物治療。兩組患者術(shù)前4小時(shí)給予0.9%的生理鹽水以1ml/kg/h靜點(diǎn),術(shù)后兩組給于靜脈注射20mg呋塞米并繼續(xù)予1ml/kg/h的生理鹽水進(jìn)行水化持續(xù)24小時(shí)。于術(shù)前和術(shù)后48小時(shí)分別測量Scr。體重指數(shù)(BMI)=體重(kg)/身高^2(m)。應(yīng)用SPSS19.0統(tǒng)計(jì)學(xué)軟件對(duì)實(shí)驗(yàn)數(shù)據(jù)進(jìn)行整理。正態(tài)分布的計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差;非正態(tài)分布計(jì)量資料采用中位數(shù)(四分位數(shù)間距);兩組間參數(shù)的比較采用獨(dú)立樣本t檢驗(yàn)。分類資料用卡方檢驗(yàn)進(jìn)行比較。采用logistic回歸分析篩選造影劑腎病的危險(xiǎn)因素。以P0.05認(rèn)為存在統(tǒng)計(jì)學(xué)差異。結(jié)果:兩組基線下臨床特點(diǎn)如性別、吸煙史、糖尿病、急性心梗、多支病變、口服他汀類、口服ACEI/ARB類、造影劑類型、射血分?jǐn)?shù)、血清BNP、血紅蛋白、C-反應(yīng)蛋白、膽固醇、血糖、24小時(shí)出入量等方面沒有統(tǒng)計(jì)學(xué)差異(P0.05)。在年齡、左室大小、E/e’、高血壓方面存在統(tǒng)計(jì)學(xué)差異(P0.05)。兩組造影劑腎病的發(fā)生率分別1.16%,9.02%,有統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析顯示,BNP升高、體重指數(shù)與造影劑腎病的發(fā)生相關(guān),為CIN危險(xiǎn)因素。體重指數(shù)判斷CIN的ROC曲線面積為0.533,界值為24.1時(shí),預(yù)測CIN的敏感性為96%,特異性為28%(95%CI:0.426-0.641;P=0.05)。結(jié)論:在水化的基礎(chǔ)上給予小劑量呋塞米,體重指數(shù)、血清BNP與造影劑腎病發(fā)生相關(guān),BNP升高、BMI≥24是CIN危險(xiǎn)因素。
[Abstract]:Background: with the widespread development of coronary intervention therapy, the increase of contrast agent in clinical use, the incidence of contrast agent nephropathy (contrast-induced nephropathy, CIN) is also increasing. The third major cause of hospital acquired acute renal injury is that [1].CIN is the complication after the use of iodine contrast agent in PCI operation and the mortality rate is 3. 5%. currently has no effective treatment for CIN, screening and assessing patients with high-risk risk before operation, correctly using and minimizing the use of contrast agents, preventive hydration and other interventions, early accurate diagnosis and treatment, reducing the incidence of CIN and endangering [2]. clinically, as CIN, as CIN (Scr) as CIN Early detection index. Age, heart failure, anemia, diabetes, hypertension have now been confirmed as CIN risk factors. With the development of social economy and the improvement of human diet, obesity has become an important problem in social health. Obesity is not only an important risk factor for coronary heart disease, hypertension and diabetes, obesity is the cause of renal function damage. Obesity related nephrosis [3]. BMI has always been a diagnostic criterion for obesity. "Ideal weight" has been pursued by the public. Obesity and CIN are associated with a common inflammatory pathway. Obesity may be associated with CIN independent [4], and obesity causes glomerular high filtration to increase renal tubule to sodium. Reabsorption, the protective effect of the kidney may reduce the [4]. purpose of CIN. This study will explore the relationship between body mass index and contrast agent nephropathy through the analysis of body mass index and the changes in the value of creatinine in the contrast agent 48h. Methods: the subjects were selected from January 2016 to December 2016 in our hospital for percutaneous coronary intervention. A total of 352 patients were performed, of which 262 were male and 90 women, with an average age of 57.94 + 9.45 years, with an average weight of 72.80 + 10.86 kilograms. All the patients were collected for clinical data including general conditions (such as weight, height, age, sex, etc.), previous history (hypertension, diabetes, hyperlipidemia, kidney disease), history of medication, physical examination To perfect the laboratory examination (including blood routine, clotting routine, liver function, renal function, electrolyte, blood lipid, blood sugar, etc.), routine electrocardiogram, chest film and cardiac ultrasound examination, other routine preoperative examination of percutaneous coronary intervention. The selected patients were divided into two groups according to body mass index, group BMI24 and BMI in groups more than 24. The two groups of patients in the two group were given 0.9% of the normal saline 4 hours before operation, and the two groups were injected with 20mg furosemide and continued to give 1ml/kg/h saline for 24 hours after the operation. The Scr. BMI was measured before and 48 hours after the operation, respectively. BMI) = weight (kg) / height ^2 (m). Use SPSS19.0 statistics software to sort out the experimental data. The measurement data of normal distribution use mean number + standard deviation; non normal distribution data use the median (four division spacing); the two groups of parameters are compared by independent sample t test. Classification data are compared with chi square test. Logi Stic regression analysis was used to screen the risk factors for contrast nephropathy. Results: two groups of baseline clinical features such as sex, smoking history, diabetes, acute myocardial infarction, multiple branch lesions, oral administration of statins, oral ACEI/ARB, contrast agent type, ejection fraction, serum BNP, hemoglobin, C- reactive protein, cholesterol, blood sugar, 24 There were no statistical differences (P0.05). There were statistical differences in age, left ventricular size, E/e ', hypertension (P0.05). The incidence of angiographic nephropathy in two groups was 1.16%, 9.02%, respectively (P0.05).Logistic regression analysis showed that BNP increased, body mass index was associated with the occurrence of contrast nephropathy, and was a risk of CIN. Factors. When the ROC curve area of CIN was 0.533 and the boundary value was 24.1, the sensitivity of the predicted CIN was 96% and the specificity was 28% (95%CI:0.426-0.641; P=0.05). Conclusion: on the basis of the hydration, the small dose furosemide, body mass index, serum BNP and contrast agent nephropathy were related, BNP increased and BMI more than 24 was a CIN risk factor.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692;R54

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