本文選題：對(duì)比劑腎病 + 尼可地爾　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:主要觀察口服尼可地爾聯(lián)合等滲造影劑對(duì)行經(jīng)皮冠狀動(dòng)脈造影術(shù)后對(duì)比劑腎病的影響。方法:詳細(xì)搜集所有入選患者的基礎(chǔ)資料,包括:性別、年齡、體重、血常規(guī)、肝功能、血肌酐、胱抑素C、β2微球蛋白、腎小球?yàn)V過(guò)率(GFR)、肌酐清除率(Ccr),有無(wú)高血壓病史及糖尿病史,基礎(chǔ)用藥情況及Mehran評(píng)分等。將所有符合入選條件而無(wú)排除條件的入選患者,按是否應(yīng)用尼可地爾及手術(shù)過(guò)程中應(yīng)用造影劑的不同分為四組,A組:常規(guī)治療+碘佛醇組;B組:常規(guī)治療+碘克沙醇組;C組:尼可地爾+碘佛醇組;D組:尼可地爾+碘克沙醇組;入選標(biāo)準(zhǔn):(1)年齡18以上。(2)擬行接受冠狀動(dòng)脈造影檢查并簽署知情同意書(shū);(3)糖尿病患者術(shù)前48小時(shí)停用二甲雙胍類(lèi)藥物。排除條件:(1)LVEF30%,且有嚴(yán)重心力衰竭癥狀患者;(2)嚴(yán)重肝、腎功能不全患者;(3)既往對(duì)含碘對(duì)比劑過(guò)敏患者;(4)7天內(nèi)使用過(guò)造影劑者;(5)既往腎移植、單體腎、需要長(zhǎng)期血液透析的患者;(6)尼可地爾不耐受患者;(7)嚴(yán)重感染的患者;(8)患有免疫系統(tǒng)疾病及血液系統(tǒng)疾病的患者;(9)凝血功能障礙者;(10)患有腫瘤性疾病者。常規(guī)治療即應(yīng)用相同抗凝、抗血小板藥物治療,同時(shí)予以ACEI/ARB、他汀類(lèi)、β受體阻滯劑或鈣通道阻滯劑藥物和硝酸酯類(lèi)藥物。不同的是C組、D組在常規(guī)治療基礎(chǔ)上加用尼可地爾片(喜格邁Nipro Pharma Corporation Kagamiishi Plant)5mg口服,3/日,術(shù)前48小時(shí)開(kāi)始應(yīng)用,連續(xù)應(yīng)用至術(shù)后第3天以上。四組患者術(shù)前術(shù)后均給予相同水化治療方案。觀察指標(biāo):患者冠脈造影術(shù)前、術(shù)后24h及術(shù)后48h血中肌酐、胱抑素C和β2微球蛋白的結(jié)果,主要終點(diǎn)事件CIN的發(fā)生率。采用SPSS 21.0統(tǒng)計(jì)軟件分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:共80例患者納入本研究,其中男性59例,女性21例;A組患者22例(男性16例,平均年齡57.91±6.63歲),B組患者18例(男性14例,平均年齡60.94±13.20歲),C組患者21例(男性16例,平均年齡57.71±9.21歲),D組患者19例(男性13例,平均年齡63.26±9.02歲)。1基礎(chǔ)資料對(duì)比分別對(duì)四組患者的入院資料進(jìn)行統(tǒng)計(jì),對(duì)計(jì)量資料:年齡、體重、造影劑用量、紅細(xì)胞比容、血紅蛋白、血肌酐、胱抑素C、β2微球蛋白、肌酐清除率(Ccr),腎小球?yàn)V過(guò)率(GFR)、Mehran評(píng)分進(jìn)行F檢驗(yàn),結(jié)果P值均0.05,無(wú)統(tǒng)計(jì)學(xué)差異;對(duì)計(jì)數(shù)資料:性別、高血壓、糖尿病、飲酒史、吸煙史以及基礎(chǔ)用藥情況,包括阿司匹林腸溶片、硫酸氫氯吡咯雷片、β受體阻滯劑、ACEI/ARB類(lèi)、他汀類(lèi)、鈣通道阻滯劑進(jìn)行了卡方檢驗(yàn),結(jié)果P值均0.05,無(wú)統(tǒng)計(jì)學(xué)差異。2四組患者CIN的發(fā)生率比較根據(jù)造影劑腎病的診斷標(biāo)準(zhǔn):排除其他腎臟損傷因素外,在造影劑應(yīng)用的24-48小時(shí)內(nèi),出現(xiàn)血清肌酐較基線水平上升25%或者上升0.5mg/dl的急性腎功能損傷。各組間CIN發(fā)生:A組發(fā)生CIN 1(1/22)例,B組發(fā)生CIN 1(1/18)例,C組發(fā)生CIN 1(1/21)例,D組發(fā)生CIN 1(1/19)例;多樣本間率比較進(jìn)行卡方檢驗(yàn),結(jié)果P=0.9990.05,無(wú)統(tǒng)計(jì)學(xué)差異。3胱抑素C及β2微球蛋白分析比較對(duì)重復(fù)測(cè)量資料的數(shù)據(jù)進(jìn)行方差分析結(jié)果如下:(1)胱抑素C的組間變異F=3.599,P=0.0170.05;而組內(nèi)變異的P0.05;(2)β2微球蛋白結(jié)果:β2微球蛋白的組間變異F=3.276,P=0.0260.05;組內(nèi)變異的P0.05。這就說(shuō)明分組因素對(duì)胱抑素C和β2微球蛋白結(jié)果存在影響。結(jié)論:尼可地爾聯(lián)合等滲造影劑對(duì)冠狀動(dòng)脈造影術(shù)后對(duì)比劑腎病未見(jiàn)明顯預(yù)防作用;但在一定程度上可以對(duì)術(shù)后患者早期腎功能具有保護(hù)作用。
[Abstract]:Objective: To observe the oral nicorandil combined with isotonic contrast agent on percutaneous coronary angiography after contrast nephropathy effect. Methods: all patients collected detailed basic information, including gender, age, body weight, blood routine, liver function, serum creatinine, Cystatin C, beta 2 microglobulin, glomerular filtration rate (GFR), creatinine clearance rate (Ccr), there is no history of hypertension and diabetes mellitus, basic medication and Mehran scores. All eligible patients were excluded without conditions, according to different applications and whether nicorandil during surgery application of contrast agents into four groups, A group: conventional treatment + ioversol group; B group: conventional treatment + iodixanol group; group C: Nicorandil + ioversol group; group D: Nicorandil + iodixanol group; inclusion criteria: (1) the age of 18. (2) underwent receiving coronary angiography and signed informed consent; (3) Diabetic patients 48 hours before discontinuation of metformin drugs. Exclusion criteria: (1) LVEF30%, and patients with severe heart failure symptoms; (2) severe liver and renal insufficiency patients; (3) prior to iodinated contrast agent allergy patients; (4) within 7 days after use of contrast agent (5); previous kidney transplantation, single kidney, need long-term hemodialysis patients; (6) nicorandil intolerance; (7) patients with serious infections; (8) suffering from diseases of the immune system and blood system diseases; (9) blood coagulation dysfunction; (10) Huan Youzhong tumor disease. Routine treatment: the application of anticoagulant, antiplatelet drug therapy, at the same time be ACEI/ARB, statins, beta blockers or calcium channel blockers and nitrates drugs. Unlike the C group, D group in the conventional treatment based on the use of Nicorandil Tablets (Nipro Pharma Corporation Kagamiishi Plant hi Gemai) 5mg oral, 3/, surgery 鍓，

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