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目的:对比研究肾功能不全患者行冠状动脉介入诊治术使用等渗造影剂与低渗造影剂所致肾病的发生率和严重程度。方法:2003年3月1日至2007年9月1日收治肾功能不全住院患者461例,患者分为2组:等渗造影剂组(131例)与低渗造影剂组(330例)。全部患者行冠状动脉介入诊治术前1 d、术后第1、3、7天检测2组患者血清肌酐(SCr),并观察2组不良反应发生情况。结果:术后第1、3、7天,等渗造影剂组所致肾病累计发生率分别为6.9%、19.1%与19.8%;低渗造影剂组分别为23.9%、36.4%与39.4%,等渗造影剂组肾病发生率均低于低渗造影剂组,差异有统计学意义(均P<0.05)。术后第1及第3天,等渗造影剂组SCr浓度升高分别为(-15.8±55.5)μmol/L及(12.3±58.0)μmol/L,而低渗造影剂组分别为(20.1±53.7)μmol/L及(38.3±62.4)μmol/L,2组间比较差异有统计学意义(均P<0.05)。结论:等渗造影剂对肾功能不全患者的肾毒性较低渗造影剂轻,肾功能不全患者行冠状动脉介入术时选用等渗造影剂更安全。
OBJECTIVE: To compare the incidence and severity of nephropathy caused by the use of isotonic contrast media and hypotonic contrast media in the diagnosis and treatment of renal insufficiency in patients with renal insufficiency. Methods: 461 hospitalized patients with renal insufficiency from March 1, 2003 to September 1, 2007 were divided into two groups: isotonic contrast media (131 cases) and hypotonic contrast media (330 cases). All patients underwent coronary intervention 1 d before operation and serum creatinine (SCr) in 2 groups were detected on the 1st, 3rd, 7th day after operation. The incidence of adverse reactions in the two groups were observed. Results: On the 1st, 3rd and 7th day after operation, the cumulative incidence of nephropathy caused by isotonic contrast agent group was 6.9%, 19.1% and 19.8%, respectively. The low contrast medium group was 23.9%, 36.4% and 39.4% The incidence of nephropathy in isotonic contrast media group was lower than that in hypotonic contrast media group, the difference was statistically significant (both P <0.05). On day 1 and day 3, the SCr concentrations in the isotonic contrast medium group were (-15.8 ± 55.5) μmol / L and (12.3 ± 58.0) μmol / L, respectively, while those in the low-contrast contrast medium group were 53.7) μmol / L and (38.3 ± 62.4) μmol / L, respectively. There was significant difference between the two groups (all P <0.05). CONCLUSIONS: Isotonic contrast agents are more safe for patients with renal insufficiency who have lower nephrotoxicity than those with mild contrast media and those with renal insufficiency undergoing coronary intervention.