经皮冠状动脉介入术相关造影剂致急性肾损伤的临床观察

发布时间：2018-08-10 20:07

【摘要】：目的：通过评估经皮冠状动脉介入术术前相关临床指标,对造影剂致急性肾损伤(contrast-induced acute kidney injury,CI-AKI)的相关危险因素进行回顾性的分析,探讨造影剂致急性肾损伤的危险因素。方法：选择自2012年1月至2013年1月在武警后勤学院附属医院心血管内科行PCI的患者425例为对象,收集患者的年龄、性别、高血压、糖尿病、血脂、介入前后肾功能、造影剂用量等相关临床指标。同时排除肾移植者及肾功能衰竭需透析者、妊娠哺乳期、有含碘造影剂过敏史者、48小时内使用过非甾体抗炎药、1周内使用过肾毒性药物、4周内接触过造影剂患者等。根据CI-AKI的诊断标准将研究对象分为CI-AKI组和非CI-AKI组,来分析CI-AKI的发生率,用单因素分析和Logistic多因素回归分析CI-AKI的危险因素。结果： 1.通过比较425例行PCI患者术前术后患者血清肌酐水平,确定113例为CI-AKI,发生率为26.6%。将患者分为CI-AKI组及非CI-AKI组,对比CI-AKI组与非CI-AKI组在年龄、高血压、糖尿病、高脂血症等指标,P0.05无统计学差异；但两组性别、左心室射血分数及慢性肾功能不全病史存在明确的统计学差异(P0.05)。 2.对比两组造影剂,其中CI-AKI组为183.48±55.91ml,非CI-AKI组为190.00±60.45ml,无统计学差异(P0.05)。 3.logistic多因素回归分析：男性、CRF病史、术前Scr即为排除混杂因素后与CI-AKI发病相关的独立危险因素,按相对危险性由大到小依次为：男性(OR值5.111),CRF病史(OR值4.213),术前Scr(OR值2.995)。术前RBC(OR值0.084)、EF值(OR值0.939)为降低CI-AKI发病的保护因素。结论：慢性肾功能不全病史、男性、血清肌酐可能是造影剂致急性肾损伤的独立危险因素。术前RBC、EF值可能是造影剂致急性肾损伤的保护因素。
[Abstract]:Objective: to investigate the risk factors of acute renal injury induced by contrast agent (contrast-induced acute kidney injuryor CI-AKI) by evaluating the clinical parameters before percutaneous coronary intervention (PCI). Methods: from January 2012 to January 2013, 425 patients with PCI in Cardiovascular Department of affiliated Hospital of Armed Police Logistics College were selected as subjects. The patients' age, sex, hypertension, diabetes mellitus, blood lipid, renal function before and after intervention were collected. Contrast agent dosage and other related clinical indicators. At the same time, renal transplant recipients and renal failure patients needed dialysis, pregnancy and lactation, patients with history of iodine contrast agent allergy were treated with NSAIDs within 1 week and those who had been exposed to contrast agents within 4 weeks. According to the diagnostic criteria of CI-AKI, the subjects were divided into CI-AKI group and non-CI-AKI group to analyze the incidence of CI-AKI. Univariate analysis and Logistic multivariate regression analysis were used to analyze the risk factors of CI-AKI. Results: 1. By comparing the serum creatinine level of 425 patients with PCI before and after operation, 113 cases were confirmed as CI-AKI, the incidence rate was 26.6. The patients were divided into CI-AKI group and non-CI-AKI group. There was no significant difference in age, hypertension, diabetes mellitus, hyperlipidemia between CI-AKI group and non-CI-AKI group. Left ventricular ejection fraction and history of chronic renal insufficiency were significantly different (P0.05). The contrast medium was 183.48 卤55.91 ml in CI-AKI group and 190.00 卤60.45 ml in non-CI-AKI group (P0.05). There was no statistical difference between the two groups (P0.05). 3.logistic multivariate regression analysis showed that Scr was an independent risk factor associated with the onset of CI-AKI after exclusion of confounding factors. The order of relative risk was: male (OR 5.111), history of CRF (OR 4.213), preoperative Scr (OR (2.995). Preoperative RBC (OR value (0.084) and EF value (OR 0.939) were the protective factors to reduce the incidence of CI-AKI. Conclusion: the history of chronic renal insufficiency, male, serum creatinine may be an independent risk factor of acute renal injury induced by contrast agent. Preoperative RBCU EF may be a protective factor for acute renal injury induced by contrast agent.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.4;R692

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