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目的探讨造影剂肾病(CIN)的危险因素,并寻求预防造影剂引起的这一并发症的有效方法。方法本研究对2004年6月至2005年12月在广州医学院第二附属医院诊断为造影剂肾病的17例患者资料行回顾性分析。所用造影剂为低渗非离子型的 Iopamidol(碘帕醇,商品名碘必乐),剂量70～150 mL。造影前及造影后第2、第7天化验血肌酐(Scr)。结果所有患者造影后第2天 Scr 平均升高(82.35±99.10)μmoL/L,第7天11例患者 Scr 降至正常水平(103.82±20.49)μmol/L,6例患者 Scr 值仍高(437.83±335.85)μmol/L,其中3例患者需行血液透析治疗。结论 CIN 的危险因素包括原有肾功能不全,充血性心力衰竭,大剂量使用造影剂,糖尿病,应用肾毒性药物等。肾功能减退的患者应尽量减少造影剂用量。利尿剂和其它肾毒性药物至少在造影前后24小时停用。静脉补液和血液滤过可预防 CIN。
Objective To investigate the risk factors of contrast-induced nephropathy (CIN) and to find an effective method to prevent this complication caused by contrast medium. Methods The data of 17 patients diagnosed as contrast-induced nephropathy at the Second Affiliated Hospital of Guangzhou Medical College from June 2004 to December 2005 were retrospectively analyzed. The contrast medium used is a hypotonic non-ionic Iopamidol (iopamidol, trade name ibuprofen) in a dose of 70-150 mL. Serum creatinine (Scr) was tested before angiography and on the second and seventh days after angiography. Results Scr increased on average (82.35 ± 99.10) μmoL / L on the second day after angiography in all patients, and decreased to normal level (103.82 ± 20.49) μmol / L on the seventh day in 11 patients (437.83 ± 335.85) μmol / L, of which 3 patients required hemodialysis. Conclusion The risk factors of CIN include original renal insufficiency, congestive heart failure, high dose contrast agent, diabetes mellitus, nephrotoxic drugs and so on. Patients with hypofunction should try their best to reduce the amount of contrast medium. Diuretics and other nephrotoxic drugs are discontinued at least 24 hours before and after radiography. Intravenous fluids and hemofiltration prevent CIN.