經(jīng)皮冠狀動(dòng)脈介入治療并發(fā)對(duì)比劑腎病臨床回顧分析課件

經(jīng)皮冠狀動(dòng)脈介入治療并發(fā)對(duì)比劑腎病臨床回顧分析經(jīng)皮冠狀動(dòng)脈介入治療并發(fā)對(duì)比劑腎病臨床回顧分析1在給對(duì)比劑后48小時(shí)內(nèi)，血清肌酐會(huì)升高，并在5天內(nèi)達(dá)峰值若肌酐數(shù)值在給對(duì)比劑后48小時(shí)內(nèi)比基線值升高大于25%或升高大于0.5mg/dl研究發(fā)現(xiàn)，給予造影劑后，約60%病人肌酐水平在24小時(shí)內(nèi)升高，90%在72小時(shí)內(nèi)升高；造影后的4－5天達(dá)峰值，10天后回歸正常水平

Marenzi等人發(fā)現(xiàn)在CIN病人中，血清肌酐峰值是在術(shù)后第2天發(fā)生的Harjai等人建議，術(shù)后1.6—1.9天為隨訪腎功能的最佳時(shí)間延遲腎病造影劑腎病的定義在給對(duì)比劑后48小時(shí)內(nèi)，血清肌酐會(huì)升高，并在5天內(nèi)達(dá)峰值造影2相關(guān)國(guó)際學(xué)會(huì)和臨床指南中均已涉及

對(duì)比劑的合理應(yīng)用與對(duì)比劑腎病的預(yù)防策略ACC/SCA&I2001ClinicalExpertConsensusDocumentonCardiacCatheterizationLaboratoryStandardsACC/AHA/SCA&I2005GuidelineUpdateforPercutaneousCoronaryInterventionACC/AHA2005GuidelinesfortheManagementofPatientswithPeripheralArterialDiseaseACR2002ACRPracticeGuidelinefortheUseofIntravascularContrastMedia2003PracticeGuidelineforthePerformanceofDiagnosticArteriographyinAdultsESUR2005GuidelinesonContrastMediaFrenchSocietyofRadiology2004Préventiondel’insuffisancerénaleinduiteparlesproduitsdecontrasteiodés2005ProduitsdecontrasteiodésetdiabèteGermanCardiacSociety2005ArbeitsanweisungimHKLNKF2005K/DOQIClinicalPracticeGuidelinesforCardiovascularDiseaseinDialysisPatients相關(guān)國(guó)際學(xué)會(huì)和臨床指南中均已涉及

對(duì)比劑的合理應(yīng)用與對(duì)比劑腎3JAMA.2006;295(23):2765-2779.RiskFactorsforContrast-InducedNephropathyPatientRelatedChronickidneydiseaseDiabetesmellitusUrgent/electiveprocedureIntra-aorticballoonpumpCongestiveheartfailureAgeHypertensionLowhematocritHypotensionNotPatientRelatedContrastpropertiesHighosmolarcontrastIoniccontrastContrastviscosityContrastvolume造影劑腎病的危險(xiǎn)因子JAMA.2006;295(23):2765-2779.4沈陽軍區(qū)總醫(yī)院臨床資料回顧ToevaluationtheimpactofcontrastmediaonrenalfunctioninpatientswithcoronaryarteryangiographyorPCIandinvestigatetheriskfactorsofCINandtheeffectsofCINonclinicalprognosisinpatientsduringPCI沈陽軍區(qū)總醫(yī)院臨床資料回顧Toevaluationthe5入選標(biāo)準(zhǔn)Oct1998toDec200810305patientswithPCIorcoronaryarteryangiographyofcompletefollow-updatawereadmitted27to92years（65±12years）Tobeusedtheiso-osmia（iodixanol）orthelow-osmia（iopromide）nonioniccontrastmedium入選標(biāo)準(zhǔn)Oct1998toDec20086研究方法Serumcreatinineconcentration（SCr）wasmeasuredatbaselineandonthelst，2ndand3rddaysAllSCranalyseswereperformedatShenyangGeneralHospitalToobservemajoradversecardiacevents（MACE）duringhospitalizationToanalyzedtheincidenceoftheriskfactorsofCINretrospectively研究方法Serumcreatinineconcentra7研究結(jié)果P=0.001P=0.011P=0.022Morbidity研究結(jié)果P=0.001P=0.011P=0.022Morbi8平均應(yīng)用對(duì)比劑劑量P=0.0001研究結(jié)果平均應(yīng)用對(duì)比劑劑量P=0.0001研究結(jié)果9PCI術(shù)前與術(shù)后血壓研究結(jié)果non-CINCINP=0.003P=0.019PCI術(shù)前與術(shù)后血壓研究結(jié)果non-CINCINP=0.0010CIN的發(fā)生率P<0.0001研究結(jié)果CIN的發(fā)生率P<0.0001研究結(jié)果11平均住院天數(shù)P=0.0001研究結(jié)果平均住院天數(shù)P=0.0001研究結(jié)果12住院期間MACE發(fā)生率及病死率

研究結(jié)果non-CINCINP=0.002P=0.001住院期間MACE發(fā)生率及病死率研究結(jié)果non-CINCIN131年無事件生存率P=0.010研究結(jié)果1年無事件生存率P=0.010研究結(jié)果14結(jié)論冠心病PCI患者存在多種對(duì)比劑腎病的危險(xiǎn)因素CIN增加PCI患者住院期間主要不良心臟事件及病死率對(duì)高?；颊咝枰M(jìn)行有效的預(yù)防措施等滲非離子對(duì)比劑對(duì)腎功能的影響較小結(jié)論冠心病PCI患者存在多種對(duì)比劑腎病的危險(xiǎn)因素15路漫漫其修遠(yuǎn)兮謝謝路漫漫其修遠(yuǎn)兮謝謝16經(jīng)皮冠狀動(dòng)脈介入治療并發(fā)對(duì)比劑腎病臨床回顧分析經(jīng)皮冠狀動(dòng)脈介入治療并發(fā)對(duì)比劑腎病臨床回顧分析17在給對(duì)比劑后48小時(shí)內(nèi)，血清肌酐會(huì)升高，并在5天內(nèi)達(dá)峰值若肌酐數(shù)值在給對(duì)比劑后48小時(shí)內(nèi)比基線值升高大于25%或升高大于0.5mg/dl研究發(fā)現(xiàn)，給予造影劑后，約60%病人肌酐水平在24小時(shí)內(nèi)升高，90%在72小時(shí)內(nèi)升高；造影后的4－5天達(dá)峰值，10天后回歸正常水平

Marenzi等人發(fā)現(xiàn)在CIN病人中，血清肌酐峰值是在術(shù)后第2天發(fā)生的Harjai等人建議，術(shù)后1.6—1.9天為隨訪腎功能的最佳時(shí)間延遲腎病造影劑腎病的定義在給對(duì)比劑后48小時(shí)內(nèi)，血清肌酐會(huì)升高，并在5天內(nèi)達(dá)峰值造影18相關(guān)國(guó)際學(xué)會(huì)和臨床指南中均已涉及

對(duì)比劑的合理應(yīng)用與對(duì)比劑腎病的預(yù)防策略ACC/SCA&I2001ClinicalExpertConsensusDocumentonCardiacCatheterizationLaboratoryStandardsACC/AHA/SCA&I2005GuidelineUpdateforPercutaneousCoronaryInterventionACC/AHA2005GuidelinesfortheManagementofPatientswithPeripheralArterialDiseaseACR2002ACRPracticeGuidelinefortheUseofIntravascularContrastMedia2003PracticeGuidelineforthePerformanceofDiagnosticArteriographyinAdultsESUR2005GuidelinesonContrastMediaFrenchSocietyofRadiology2004Préventiondel’insuffisancerénaleinduiteparlesproduitsdecontrasteiodés2005ProduitsdecontrasteiodésetdiabèteGermanCardiacSociety2005ArbeitsanweisungimHKLNKF2005K/DOQIClinicalPracticeGuidelinesforCardiovascularDiseaseinDialysisPatients相關(guān)國(guó)際學(xué)會(huì)和臨床指南中均已涉及

對(duì)比劑的合理應(yīng)用與對(duì)比劑腎19JAMA.2006;295(23):2765-2779.RiskFactorsforContrast-InducedNephropathyPatientRelatedChronickidneydiseaseDiabetesmellitusUrgent/electiveprocedureIntra-aorticballoonpumpCongestiveheartfailureAgeHypertensionLowhematocritHypotensionNotPatientRelatedContrastpropertiesHighosmolarcontrastIoniccontrastContrastviscosityContrastvolume造影劑腎病的危險(xiǎn)因子JAMA.2006;295(23):2765-2779.20沈陽軍區(qū)總醫(yī)院臨床資料回顧ToevaluationtheimpactofcontrastmediaonrenalfunctioninpatientswithcoronaryarteryangiographyorPCIandinvestigatetheriskfactorsofCINandtheeffectsofCINonclinicalprognosisinpatientsduringPCI沈陽軍區(qū)總醫(yī)院臨床資料回顧Toevaluationthe21入選標(biāo)準(zhǔn)Oct1998toDec200810305patientswithPCIorcoronaryarteryangiographyofcompletefollow-updatawereadmitted27to92years（65±12years）Tobeusedtheiso-osmia（iodixanol）orthelow-osmia（iopromide）nonioniccontrastmedium入選標(biāo)準(zhǔn)Oct1998toDec200822研究方法Serumcreatinineconcentration（SCr）wasmeasuredatbaselineandonthelst，2ndand3rddaysAllSCranalyseswereperformedatShenyangGeneralHospitalToobservemajoradversecardiacevents（MACE）duringhospitalizationToanalyzedtheincidenceoftheriskfactorsofCINretrospectively研究方法Serum