探讨慢性肾脏疾病合并冠心病患者的水化方案及临床疗效

周锡平; 彭永权

doi:10.13201/j.issn.1001-1439.2018.04.010

探讨慢性肾脏疾病合并冠心病患者的水化方案及临床疗效

周锡平^,,
彭永权

- 西南医科大学附属医院心血管内科(四川泸州, 646000)

详细信息

通讯作者: 周锡平,E-mail:nbuw18@163.com

中图分类号: R541.4

收稿日期: 2017-09-18

Preventive effect of central venous pressure-guided fluid administration on contrast-induced nephropathy in patients with chronic kidney disease and coronary heart disease

ZHOU Xiping^,,
PENG Yongquan

- Department of Cardiology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China

More Information

Corresponding author: ZHOU Xiping, E-mail: nbuw18@163.com

Received Date: 18 September 2017

摘要

摘要: 目的:探讨中心静脉压 (CVP) 指导慢性肾脏疾病 (CKD) 合并冠心病 (CHD) 患者水化对降低造影剂肾病 (CIN) 风险的临床效果。方法:选择于我院心内科接受经皮冠状动脉介入治疗 (PCI) 的CKD合并CHD患者149例作为前瞻性观察研究对象, 随机分为CVP组 (73例) 和对照组 (76例)。CVP组根据动态监测CVP的结果每小时精细地调整水化补液速度, 对照组的水化补液速度为1ml·kg^-1·h^-1[左室射血分数 (LVEF) ＜40%的患者为0.5ml·kg^-1·h^-1]。主要终点事件为CIN的发生率。结果:与对照组相比, CVP组的水化体积显著提高 (P＜0.05), 其他基线特征相似 (P＞0.05)。CVP组和对照组PCI后CIN的发生率分别为5.5%和11.8%, 组间比较差异无统计学意义 (P=0.169)。CVP组暴露于造影剂后48h内绝对肌酐 (SCr) 水平显著低于对照组[(-0.01±0.43) mg/dl:(0.07±0.31) mg/dl, P=0.005]。在住院期间和手术后90d内, CVP组累积次要不良事件发生率为6.8%, 对照组为18.4%, 组间比较差异有统计学意义 (P=0.034)。结论:CVP指导水化较标准水化方案并不能更好地降低CIN的发生风险。
- 水化 /
- 中心静脉压 /
- 慢性肾脏疾病 /
- 冠心病 /
- 造影剂肾病
Abstract: Objective: This study aimed to explore the hemodynamic index-guided hydration method for patients with coronary heart disease (CHD) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN).Method: This prospective, randomized clinical trial enrolled 149 consecutive patients with CKD and CHD undergoing coronary procedures.These patients were randomly assigned to either central venous pressure (CVP) group (n=73) or the control group (n=76).In the CVP group, the hydration infusion rate was dynamically adjusted according to CVP level every hour.An intravenous infusion of 0.45% saline at a rate of 1 ml·kg^-1·h^-1 (0.5 ml·kg^-1·h^-1 for patients with LVEF＜40%) was given to the control group.The primary endpoint was the incidence of CIN.Result: Compared with the control group, the hydration volume of CVP group was significantly increased (P＜0.05), and other baseline characteristics were similar (P＞0.05).The incidence of CIN in CVP group and control group were 5.5% and 11.8% respectively, the difference was not statistically significant (P=0.169).The absolute SCr levels in the CVP group exposed to contrast medium for 48 hwere significantly lower than those in the control group [(-0.01±0.43) mg/ml vs (0.07±0.31) mg/ml, P=0.005].During the hospital stay and out to 90 days after the procedure, myocardial infarction incidence was much lower in the CVP group than in the control group (6.8% vs 18.4%, P=0.034).Conclusion: CVP-guided hydration is not able to produce a better risk of CIN than standard hydration regimen.
- hydration /
- central venous pressure /
- chronic kidney disease /
- coronary heart disease /
- contrast-induced nephropathy

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