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目的观察慢性肾脏病患者在围造影期随机应用生理盐水和碳酸氢钠两种不同干预方法后造影剂肾病的发生率,验证并比较两种预防方法的有效性。方法将拟行冠状动脉造影并伴有肾功能损害的患者,随机分为碳酸氢钠组和生理盐水组。两组分别从造影前6h开始给予1.5%碳酸氢钠注射液或0.9%氯化钠注射液,按2ml/(kg.h)速度静脉输注,最大速度≤150ml/h。造影中至造影结束后6h,以80ml/h速度继续静脉输注。造影剂均使用碘海醇,记录使用剂量。分别测定造影前和造影后24h、72h的血清肌酐、尿素氮,比较两组患者造影剂肾病的发生率。结果105例患者年龄43～88岁,平均(70.51±7.69)岁。两组患者在性别、年龄、BMI、合并糖尿病病史和高血压病史、eGFR、血脂和血糖水平、碘海醇用量上均无显著性差异。血清肌酐水平在造影前碳酸氢钠组高于生理盐水组[(110.5±27.4)μmol/Lvs(102.5±13.3)μmol/L,P=0.043]。两组患者共发生造影剂肾病8例(7.62%),其中碳酸氢钠组1例(1.82%),生理盐水组7例(14%),两组造影剂肾病的发生率具有显著性差异(P=0.026)。结论与0.9%氯化钠注射液比较,围造影期应用1.5%碳酸氢钠静脉滴注能进一步降低已有肾功能损害患者造影剂肾病的发生,有效地保护肾脏功能。
Objective To observe the incidence of contrast-induced nephropathy in patients with chronic kidney disease undergoing contrast-enhanced saline and sodium bicarbonate randomization during the imaging period, and to verify and compare the effectiveness of the two preventive methods. Methods Patients undergoing coronary angiography with renal impairment were randomly divided into sodium bicarbonate group and saline group. The two groups were given 1.5% sodium bicarbonate injection or 0.9% sodium chloride injection 6 hours before imaging, according to the speed of 2ml / (kg.h) intravenous infusion, the maximum speed ≤ 150ml / h. Imaging to 6h after the end of the contrast, to 80ml / h speed intravenous infusion. Contrast agents are used iohexol, record the use of dose. Serum creatinine and urea nitrogen were measured before angiography and at 24h and 72h after angiography. The incidence of contrast-induced nephropathy was compared between the two groups. Results 105 patients aged 43 to 88 years, with an average (70.51 ± 7.69) years. There was no significant difference between the two groups in terms of gender, age, BMI, history of diabetes mellitus and history of hypertension, eGFR, blood lipid and blood glucose levels, and the dosage of iohexol. Serum creatinine was higher in sodium bicarbonate group than that in saline group [(110.5 ± 27.4) μmol / L vs (102.5 ± 13.3) μmol / L, P = 0.043] before angiography. There were 8 cases (7.62%) of contrast agent nephropathy in both groups, of which 1 case (1.82%) in sodium bicarbonate group and 7 cases (14%) in saline group. The incidence of contrast agent nephropathy was significantly different between the two groups P = 0.026). Conclusions Compared with 0.9% sodium chloride injection, 1.5% sodium bicarbonate intravenous infusion during the imaging period can further reduce the incidence of contrast-induced nephropathy in patients with renal dysfunction and effectively protect renal function.