经皮冠状动脉介入治疗并发对比剂肾病的临床回顾分析课件

经皮冠状动脉介入治经皮冠状动脉介入治疗并发对比剂肾病的疗并发对比剂肾病的临床回顾分析临床回顾分析赵昕赵昕 韩雅玲韩雅玲 王效增王效增 王守力王守力 荆全民荆全民上海上海上海上海 2009.09.27 2009.09.27经皮冠状动脉介入治疗并发对比剂肾病的临床回顾分析上海 2001在给对比剂后48小时内，血清肌酐会升高，并在5天内达峰值若肌酐数值在给对比剂后48小时内比基线值升高大于25%或升高大于0.5mg/dl研究发现，给予造影剂后，约60%病人肌酐水平在24小时内升高，90%在72小时内升高；造影后的45天达峰值，10天后回归正常水平 Marenzi等人发现在CIN病人中，血清肌酐峰值是在术后第2天发生的 Harjai等人建议，术后1.61.9天为随访肾功能的最佳时间延迟肾病造影剂肾病的定义造影剂肾病的定义在给对比剂后48小时内，血清肌酐会升高，并在5天内达峰值造影2相关国际学会和临床指南中均已涉及相关国际学会和临床指南中均已涉及对比剂的合理应用与对比剂肾病的预防策略对比剂的合理应用与对比剂肾病的预防策略ACC/SCA&I2001 Clinical Expert Consensus Document on Cardiac Catheterization Laboratory StandardsACC/AHA/SCA&I2005 Guideline Update for Percutaneous Coronary InterventionACC/AHA2005 Guidelines for the Management of Patients with Peripheral Arterial DiseaseACR2002 ACR Practice Guideline for the Use of Intravascular Contrast Media 2003 Practice Guideline for the Performance of Diagnostic Arteriography in AdultsESUR 2005 Guidelines on Contrast MediaFrench Society of Radiology2004 Prvention de linsuffisance rnale induite par les produits de contraste iods2005 Produits de contraste iods et diabteGerman Cardiac Society2005 Arbeitsanweisung im HKLNKF2005 K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients相关国际学会和临床指南中均已涉及对比剂的合理应用与对比剂肾3JAMA.2006;295(23):2765-2779.Risk Factors for Contrast-InducedNephropathy Patient RelatedChronic kidney diseaseDiabetes mellitusUrgent/elective procedureIntra-aortic balloon pumpCongestive heart failureAgeHypertensionLow hematocritHypotensionNot Patient RelatedContrast propertiesHigh osmolar contrastIonic contrastContrast viscosityContrast volume造影剂肾病的危险因子造影剂肾病的危险因子JAMA.2006;295(23):2765-2779.4沈阳军区总医院临床资料回顾To evaluation the impact of contrast media on renal function in patients with coronary artery angiography or PCI and investigate the risk factors of CIN and the effects of CIN on clinical prognosis in patients during PCI 沈阳军区总医院临床资料回顾To evaluation the5入选标准Oct 1998 to Dec 200810305 patients with PCI or coronary artery angiography of complete follow-up data were admitted 27 to 92 years（6512years）To be used the iso-osmia（iodixanol）or the low-osmia（iopromide）nonionic contrast medium 入选标准Oct 1998 to Dec 20086研究方法Serum creatinine concentration（SCr）was measured at baseline and on the lst，2nd and 3rd days All SCr analyses were performed at Shenyang General Hospital To observe major adverse cardiac events（MACE）during hospitalization To analyzed the incidence of the risk factors of CIN retrospectively 研究方法Serum creatinine concentra7研究结果P=0.001P=0.011P=0.022Morbidity 研究结果P=0.001P=0.011P=0.022Morbi8平均应用对比剂剂量平均应用对比剂剂量P=0.0001研究结果平均应用对比剂剂量P=0.0001研究结果9PCI术前与术后血压术前与术后血压研究结果non-CINCINP=0.003P=0.019PCI术前与术后血压研究结果non-CINCINP=0.0010CIN的发生率的发生率P0.0001研究结果CIN的发生率P0.0001研究结果11平均住院天数平均住院天数P=0.0001研究结果平均住院天数P=0.0001研究结果12住院期间住院期间MACE发生率及病死率发生率及病死率 研究结果non-CINCINP=0.002P=0.001住院期间MACE发生率及病死率 研究结果non-CINCIN131年无事件生存率年无事件生存率P=0.010研究结果1年无事件生存率P=0.010研究结果14结 论|冠心病PCI患者存在多种对比剂肾病的 危险因素|CIN增加PCI患者住院期间主要不良心脏事件及病死率|对高危患者需要进行有效的预防措施|等渗非离子对比剂对肾功能的影响较小结 论冠心病PCI患者存在多种对比剂肾病的 危险因素1516写在最后写在最后成功的基础在于好的学习习惯成功的基础在于好的学习习惯The foundation of success lies in good habits16写在最后成功的基础在于好的学习习惯谢谢聆听 学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard,Is A Process To Overcome Various Difficulties For A Goal谢谢聆听Learning Is To Achieve A C17