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目的比较应用质量分数0.45%及0.9%氯化钠注射液、质量分数1.25%碳酸氢钠注射液3种水化治疗方案,预防伴肾功能不全急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneouscoronary intervention,PCI)术后造影剂肾病的效果。方法血肌酐>97μmol/L并行PCI术ACS患者300例随机分为A、B、C 3组各100例,分别应用质量分数0.45%、0.9%氯化钠注射液及质量分数1.25%碳酸氢钠注射液3种水化治疗方案,测定3组血肌酐、血尿酸及半胱氨酸蛋白酶抑制剂C水平,比较3组造影剂肾病(contrast induced nephropathy,CIN)发生率,Kaplan-Meier(K-M)生存曲线预测发生CIN对患者远期预后的影响。结果 A、B、C组术后48h血肌酐分别为(116.91±20.47)、(113.39±12.08)、(110.61±12.55)μmol/L,A组高于B、C组(P<0.05),B组与C组比较差异无统计学意义(P>0.05);A、B、C组CIN发生率分别为12%、4%、3%,3组比较差异有统计学意义(P<0.05);K-M生存曲线显示,PCI术后发生CIN者再次发生心绞痛或心肌梗死等终点事件的风险明显高于未发生CIN者(P<0.05)。结论伴有肾功能不全ACS患者行PCI术前、术后应用质量分数1.25%碳酸氢钠注射液进行水化治疗,可有效预防CIN发生,改善患者远期预后。
Objective To compare three hydration regimens of 0.45% and 0.9% sodium chloride injection and 1.25% sodium bicarbonate injection in the prevention of acute coronary syndrome (ACS) patients with renal insufficiency Effect of contrast agent nephropathy after percutaneous coronary intervention (PCI). Methods 300 patients with serum creatinine> 97μmol / L and PCI were randomly divided into two groups (A, B and C), 100 cases in each group. The patients were treated with 0.9% sodium chloride injection and 1.25% sodium bicarbonate Injection of three kinds of hydration treatment programs were measured in three groups of serum creatinine, serum uric acid and cysteine proteinase inhibitor C levels were compared three groups contrast agent nephropathy (CIN) incidence, Kaplan-Meier (KM) Survival curves predict the effect of CIN on long-term prognosis in patients. Results Serum creatinine of group A, B and C were (116.91 ± 20.47), (113.39 ± 12.08) and (110.61 ± 12.55) μmol / L respectively at 48 hours after operation, There was no significant difference between group C and C (P> 0.05). The incidence of CIN in group A, B and C were 12%, 4% and 3% respectively. There was significant difference between the three groups (P <0.05). KM survival curves showed that the risk of recurrence of angina or myocardial infarction was significantly higher in patients with CIN after PCI than those without CIN (P <0.05). Conclusions ACS patients with renal insufficiency underwent preoperative and postoperative PCI with hydration of 1.25% sodium bicarbonate injection, which can effectively prevent the occurrence of CIN and improve the long-term prognosis of patients.