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为探讨造影剂对儿童肾功能的不良影响 ,以及水化对造影剂相关性肾病 (CAN)的预防作用 ,将需做静脉肾盂造影或增强CT的30例患儿 ,采用前瞻性随机对照方法 ,随机分为水化组 (HG)和非水化组 (NHG) ,HG于造影后立即给予1/5张含钠维持液20ml/kg ,NHG不予静脉补液。结果显示 ,造影后HG血清肌酐 (Scr) (49.9μmol/L±6.2μmol/L)低于NHG(58.0μmol/L±11.8μmol/L) ,P<0.05 ;而内生肌酐清除率 (Ccr)HG(89.3ml/min±13.2ml/min)明显高于NHG(70.9ml/min±8.8ml/min) ,P<0.05。HG患儿的Scr、Ccr在造影前后差异无显著性 ;虽然NHG患儿造影前后Scr无明显变化(53.1μmol/L±8.0μmol/Lvs58.0μmol/L±11.8μmol/L,P<0.05) ,但Ccr造影后明显降低 (95.9ml/min±14.4ml/minvs70.9ml/min±8.8ml/min,P<0.05)。CAN发病率为16.7 % ,HG无1例发生CAN ,而NHG5/15例发生CAN(33.3% )。其中4例在3天后Scr及Ccr恢复至造影前水平。本研究中基础Scr>61.9μmol/L的3例患儿有2例发生CAN(66.7% )。表明儿童应用碘造影剂后可出现可逆性的CAN ;造影后即刻给予水化可有效地预防CAN的发生 ;儿童Scr>61.9μmol/L时做IVP或增强CT时 ,应密切观察肾功能的改变
To investigate the adverse effect of contrast medium on children’s renal function and the preventive effect of hydration on contrast-induced nephropathy (CAN), 30 children who needed to undergo intravenous pyelography or enhanced CT were prospectively randomized controlled. Randomly divided into hydration group (HG) and non-hydration group (NHG), HG immediately after angiography given 1/5 sodium maintenance solution 20ml / kg, NHG no intravenous rehydration. The results showed that HG serum creatinine (49.9μmol / L ± 6.2μmol / L) was lower than NHG (58.0μmol / L ± 11.8μmol / L) HG (89.3 ml / min ± 13.2 ml / min) was significantly higher than NHG (70.9 ml / min ± 8.8 ml / min), P <0.05. There were no significant differences in Scr and Ccr before and after angiography in HG children. Although there was no significant change in Scr before and after angiography (53.1μmol / L ± 8.0μmol / L vs 58.0μmol / L ± 11.8μmol / L, P <0.05) However, Ccr imaging was significantly reduced (95.9 ml / min ± 14.4 ml / min vs 70.9 ml / min ± 8.8 ml / min, P <0.05). The incidence of CAN was 16.7%, none in HG and CAN in NHG5 / 15 (33.3%). In 4 of them, Scr and Ccr returned to pre-contrast level after 3 days. In the present study, CAN (66.7%) occurred in 2 of 3 children with basal Scr> 61.9 μmol / L. Show that children with iodine contrast agent can appear reversible CAN; Hydration given immediately after the contrast can effectively prevent the occurrence of CAN; children with Scr> 61.9μmol / L when IVP or enhanced CT should be closely observed changes in renal function