CT增强检查中不同水化方式预防碘造影剂肾损伤的研究

发布时间：2018-05-19 02:19

本文选题：增强CT + 口服水化　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨对于CT增强检查中肾功能正常的A、B两组患者(A组无糖尿病、无高血压;B组有糖尿病或高血压),口服和静脉两种水化方式预防碘造影剂肾损伤的效果,为CT增强检查中水化方式的选择提供理论依据。对象与方法:选取2015.9-2017.1在我院行增强CT检查符合纳入和排除标准的患者126人,按照是否伴有糖尿病、高血压分为A组(无糖尿病、无高血压)64人、B组(有糖尿病或高血压)62人。然后按将A组患者随机分为A1组31人、A2组33人。B组患者随机分为B1组32人、B2组30人。A1组与B1组实施口服水化方案,A2组与B2实施静脉水化方案,具体分组:A1组(口服水化组)、A2组(静脉水化组),B1组(口服水化组)、B2组(静脉水化组)。收集所有患者CT增强前(24h以内)、增强后第1天、第3天、第7天的肾功能各指标化验结果,包括α1微球蛋白(α1-Microglobulin)、β2微球蛋白(β2-Microglobulin)、胱抑素(Cystatin-C,Cys C)、肌酐(Serum creatinine,SCr)、尿素氮(Blood urea nitrogen,BUN),并根据造影剂肾病概念判定造影剂肾病发生率。比较A1、A2各组组内增强前与增强后第1天、第3天、第7天肾功能各指标变化情况及A1、A2两组对应时间(增强前、增强后1d、后3d、后7d)肾功能各指标变化情况。分析B1、B2各组组内增强前与增强后第1天、第3天、第7天肾功能各指标变化情况及B1、B2两组对应时间(增强前、增强后1d、后3d、后7d)肾功能各指标变化情况。比较A1与A2两组造影剂肾病发生率,B1与B2两组造影剂肾病发生率。采用SPSS20.0统计学软件分析数据,用到的方法有t检验,卡方检验,方差分析,检验水准α=0.05,以P0.05表示差异有统计学意义。结果:1.A1组CT增强前与增强后各时间段肾功能各项指标比较无统计学差异(p0.05)。2.A2组CT增强前与增强后各时间段肾功能各项指标比较无统计学差异(p0.05)。3.A1、A2两组组间CT增强前、后各时间段肾功能各项指标比较无统计学差异(p0.05)。4.B1组CT增强前与增强后各时间段肾功能各项指标比较无统计学差异,(p0.05)。5.B2组CT增强前与增强后各时间段肾功能各项指标比较无统计学差异(p0.05)。6.B1、B2两组组间CT增强前、后各时间段肾功能各项指标比较无统计学差异(p0.05)。7.A1、A2两组造影剂肾病发生率无统计学差异(p0.05)。8.B1、B2两组造影剂肾病发生率无统计学差异(p0.05)。结论:1.对于行CT增强检查的肾功能正常患者,口服水化方法与静脉水化方法对预防非离子型碘造影剂所引起的肾损伤具有同等效果。2.相比静脉水化,口服水化简便易行,增加了患者舒适度,降低了医疗成本,值得在CT增强检查中推广使用。
[Abstract]:Objective: to investigate the effect of oral and intravenous hydration on the prevention of renal injury caused by iodine contrast agent in group A and group B without diabetes mellitus and hypertension in group A and group B with normal renal function during CT enhancement. To provide a theoretical basis for the selection of hydration mode in CT enhanced examination. Participants and methods: 126 patients with hypertension were divided into group A (no diabetes, 64 patients without hypertension) and group B (62 patients with diabetes mellitus or hypertension) according to whether they were accompanied by diabetes mellitus or not, according to 126 patients who met the criteria of inclusion and exclusion by contrast-enhanced CT in our hospital from January to July 2015.These patients were divided into two groups: no diabetes, no hypertension and no hypertension. Then the patients in group A were randomly divided into group A1 (group A 1, n = 31), group A 2 (n = 33), group B (n = 33), group B _ 1 (n = 32), group B _ 2 (n = 30), group A _ 1 and group B _ 1 (n = 30) were given oral hydration regimen and group A _ 2 and group B _ 2 were treated with intravenous hydration. They were divided into two groups: group A _ 1 (group A _ 2) (Group B _ 1) (Group B _ 1) (Group B _ 2). The renal function indexes were collected from all the patients within 24 hours before CT enhancement, and on the 1st, 3rd and 7th day after enhancement. It included 伪 1-microglobulin (尾 2-microglobulin), cystatin (cystatin), creatinine (creatinine), urea nitrogen (urea) urea nitrogenbun (BUNA). The incidence of contrast agent nephropathy was determined according to the concept of contrast agent nephropathy. To compare the changes of renal function indexes before and after enhancement in A1A 2 group and the corresponding time (before enhancement, 1 day after enhancement, 3 days after enhancement, 7 days after enhancement) and at the corresponding time (before enhancement, 1 day after enhancement, 3 days after enhancement, 7 days after enhancement). The changes of indexes of renal function before and after enhancement and the corresponding time (before enhancement, 1 d, 3 d, 7 d) of B1B 2 group were analyzed. The changes of renal function indexes were analyzed before, 1 day after enhancement, 3 days after enhancement and 7 days after enhancement. The incidence of contrast agent nephropathy in group A 1 and group A 2 was compared with that in group B 1 and group B 2. SPSS20.0 statistical software was used to analyze the data, the methods used were t-test, chi-square test, variance analysis, test level 伪 0.05, the difference was statistically significant with P0.05. Results there was no significant difference in renal function indexes before and after CT enhancement in group 1: 1. There was no significant difference in renal function indexes before and after CT enhancement in group A 2. There was no significant difference between group A 2 and group A 2 before and after CT enhancement, and there was no significant difference between group A 2 and group A 2 before CT enhancement. There was no statistical difference in the indexes of renal function between the groups before and after CT enhancement. There was no statistical difference between the indexes of renal function before and after CT enhancement. There was no significant difference in the indexes of renal function before and after CT enhancement in group P0.05. 5.B2. The indexes of renal function before and after CT enhancement in group B 1 were not significantly different from those in group B 1 before and after CT enhancement. There was no statistical difference between the two groups before CT enhancement. There was no significant difference in the incidence of contrast agent nephropathy between the two groups. There was no significant difference in the incidence of contrast agent nephropathy between the two groups. Conclusion 1. For patients with normal renal function after CT enhancement, oral hydration and intravenous hydration have the same effect on preventing renal injury caused by Nonionic iodine contrast agent. Compared with intravenous hydration, oral hydration is simple and easy, increases patient comfort, reduces medical cost, and is worth popularizing in CT enhanced examination.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

【参考文献】