尼可地尔联合等渗造影剂对冠脉造影术后对比剂肾病的预防研究

发布时间：2018-04-11 07:26

  本文选题：对比剂肾病 + 尼可地尔　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:主要观察口服尼可地尔联合等渗造影剂对行经皮冠状动脉造影术后对比剂肾病的影响。方法:详细搜集所有入选患者的基础资料,包括:性别、年龄、体重、血常规、肝功能、血肌酐、胱抑素C、β2微球蛋白、肾小球滤过率(GFR)、肌酐清除率(Ccr),有无高血压病史及糖尿病史,基础用药情况及Mehran评分等。将所有符合入选条件而无排除条件的入选患者,按是否应用尼可地尔及手术过程中应用造影剂的不同分为四组,A组:常规治疗+碘佛醇组;B组:常规治疗+碘克沙醇组;C组:尼可地尔+碘佛醇组;D组:尼可地尔+碘克沙醇组;入选标准:(1)年龄18以上。(2)拟行接受冠状动脉造影检查并签署知情同意书;(3)糖尿病患者术前48小时停用二甲双胍类药物。排除条件:(1)LVEF30%,且有严重心力衰竭症状患者;(2)严重肝、肾功能不全患者;(3)既往对含碘对比剂过敏患者;(4)7天内使用过造影剂者;(5)既往肾移植、单体肾、需要长期血液透析的患者;(6)尼可地尔不耐受患者;(7)严重感染的患者;(8)患有免疫系统疾病及血液系统疾病的患者;(9)凝血功能障碍者;(10)患有肿瘤性疾病者。常规治疗即应用相同抗凝、抗血小板药物治疗,同时予以ACEI/ARB、他汀类、β受体阻滞剂或钙通道阻滞剂药物和硝酸酯类药物。不同的是C组、D组在常规治疗基础上加用尼可地尔片(喜格迈Nipro Pharma Corporation Kagamiishi Plant)5mg口服,3/日,术前48小时开始应用,连续应用至术后第3天以上。四组患者术前术后均给予相同水化治疗方案。观察指标:患者冠脉造影术前、术后24h及术后48h血中肌酐、胱抑素C和β2微球蛋白的结果,主要终点事件CIN的发生率。采用SPSS 21.0统计软件分析,以P0.05为差异有统计学意义。结果:共80例患者纳入本研究,其中男性59例,女性21例;A组患者22例(男性16例,平均年龄57.91±6.63岁),B组患者18例(男性14例,平均年龄60.94±13.20岁),C组患者21例(男性16例,平均年龄57.71±9.21岁),D组患者19例(男性13例,平均年龄63.26±9.02岁)。1基础资料对比分别对四组患者的入院资料进行统计,对计量资料:年龄、体重、造影剂用量、红细胞比容、血红蛋白、血肌酐、胱抑素C、β2微球蛋白、肌酐清除率(Ccr),肾小球滤过率(GFR)、Mehran评分进行F检验,结果P值均0.05,无统计学差异;对计数资料:性别、高血压、糖尿病、饮酒史、吸烟史以及基础用药情况,包括阿司匹林肠溶片、硫酸氢氯吡咯雷片、β受体阻滞剂、ACEI/ARB类、他汀类、钙通道阻滞剂进行了卡方检验,结果P值均0.05,无统计学差异。2四组患者CIN的发生率比较根据造影剂肾病的诊断标准:排除其他肾脏损伤因素外,在造影剂应用的24-48小时内,出现血清肌酐较基线水平上升25%或者上升0.5mg/dl的急性肾功能损伤。各组间CIN发生:A组发生CIN 1(1/22)例,B组发生CIN 1(1/18)例,C组发生CIN 1(1/21)例,D组发生CIN 1(1/19)例;多样本间率比较进行卡方检验,结果P=0.9990.05,无统计学差异。3胱抑素C及β2微球蛋白分析比较对重复测量资料的数据进行方差分析结果如下:(1)胱抑素C的组间变异F=3.599,P=0.0170.05;而组内变异的P0.05;(2)β2微球蛋白结果:β2微球蛋白的组间变异F=3.276,P=0.0260.05;组内变异的P0.05。这就说明分组因素对胱抑素C和β2微球蛋白结果存在影响。结论:尼可地尔联合等渗造影剂对冠状动脉造影术后对比剂肾病未见明显预防作用;但在一定程度上可以对术后患者早期肾功能具有保护作用。
[Abstract]:Objective: To observe the oral nicorandil combined with isotonic contrast agent on percutaneous coronary angiography after contrast nephropathy effect. Methods: all patients collected detailed basic information, including gender, age, body weight, blood routine, liver function, serum creatinine, Cystatin C, beta 2 microglobulin, glomerular filtration rate (GFR), creatinine clearance rate (Ccr), there is no history of hypertension and diabetes mellitus, basic medication and Mehran scores. All eligible patients were excluded without conditions, according to different applications and whether nicorandil during surgery application of contrast agents into four groups, A group: conventional treatment + ioversol group; B group: conventional treatment + iodixanol group; group C: Nicorandil + ioversol group; group D: Nicorandil + iodixanol group; inclusion criteria: (1) the age of 18. (2) underwent receiving coronary angiography and signed informed consent; (3) Diabetic patients 48 hours before discontinuation of metformin drugs. Exclusion criteria: (1) LVEF30%, and patients with severe heart failure symptoms; (2) severe liver and renal insufficiency patients; (3) prior to iodinated contrast agent allergy patients; (4) within 7 days after use of contrast agent (5); previous kidney transplantation, single kidney, need long-term hemodialysis patients; (6) nicorandil intolerance; (7) patients with serious infections; (8) suffering from diseases of the immune system and blood system diseases; (9) blood coagulation dysfunction; (10) Huan Youzhong tumor disease. Routine treatment: the application of anticoagulant, antiplatelet drug therapy, at the same time be ACEI/ARB, statins, beta blockers or calcium channel blockers and nitrates drugs. Unlike the C group, D group in the conventional treatment based on the use of Nicorandil Tablets (Nipro Pharma Corporation Kagamiishi Plant hi Gemai) 5mg oral, 3/, surgery 鍓，

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