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阿托伐他汀联合水化预防冠状动脉介入术后造影剂肾病的临床研究_论文

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472 内科急危重症杂志 2017 年 第 23 卷 第6 期 阿托伐他汀联合水化预防冠状动脉 介入术后造影剂肾病的临床研究 安徽省合肥市解放军第 105 医院 摘要 徐猛 许良兰 * 章福彬 孙磊, 合肥 230000 目的: 比较 60 mg / d 与 40 mg / d 阿托伐他汀分别联合水化预防急性心肌梗死 ( AMI ) 患者经皮冠状动脉介 入( PCI) 术后造影剂肾病( CIN) 的效果。方法: 选取 172 例 AMI 患者随机分为高剂量组 ( 88 例) 与低剂量组( 84 例 ) , 在常规 PCI 治疗基础上, 高剂量组患者入院后至术后 72 h 口服阿托伐他汀 60 mg / d, 低剂量组口服阿托伐他汀 40 mg / d, 同时 2 组患者围术期均予静脉滴注生理盐水水化治疗 , 记录 2 组手术指标、 治疗前、 后生物学标志物及肾功 能变化, 比较 2 组 CIN 及临床不良事件发生率 。结果: 2 组患者造影剂用量、 接触时间、 水化量及冠状动脉旋磨比例 、 *均每例患者支架植入数量差异均无统计学意义 ( 均 P > 0. 05 ) 。 高剂量组术后 3 d 外周血血清 N末端脑钠肽前体 ( NTproBNP) 、 CRP) 、 9 ) 较术前下降数值均显著高于低剂量组 [ ( 0. 5 ? 超敏 C反应蛋白( hs金属基质蛋白酶( MMP0. 2 ) pg / mL vs ( 0. 4 ? 0. 2 ) pg / mL, ( 7. 8 ? 2. 4 ) mg / L vs ( 6. 3 ? 1. 9 ) mg / L, ( 27. 5 ? 9. 5 ) μg / L vs ( 23. 7 ? 7. 7 ) μg / L, 均 ( P < 0. 05 ) ] 。高剂量组术后 3 d 血肌肝( Scr) 、 尿素氮 ( BUN ) 较术前升高数值及肾小球滤过率 ( eGFR ) 下降数值均 ( 11. 9 ? 3. 5 ) μmol / L vs ( 19. 6 ? 5. 8 ) μmol / L, ( 1. 5 ? 0. 5 ) mmol / L vs ( 2. 4 ? 0. 7 ) mmol / L, ( 5. 0 ? 显著低于低剂量组[ 。高剂量组术后 CIN 发生率、 2. 2 ) mL / ( min·1. 73m2 ) vs ( 9. 2 ? 3. 8 ) mL / ( min ·1. 73m2 ) , 均 P < 0. 05 ] 肾脏透析治 6. 8% vs 16. 7% , 1. 1% vs 8. 3% , 。结论: PCI 围手术期口服阿托伐他汀联 疗比例均显著低于低剂量组[ 均 P < 0. 05 ] 60 mg / d 的预防效果优于 40 mg / d。 合常规水化能预防 CIN 的发生, 关键词 经皮冠状动脉介入术; 造影剂肾病; 阿托伐他汀; 生物标志物; 肾功能 R541. 4 文献标识码 A DOI 10. 11768 / nkjwzzzz20170609 中图分类号 Clinical study of atorvastatin combined with hydration to prevent contrastinduced nephropathy after percutaneous coronary intervention XU Meng, XU Lianglan* , ZHANG Fubin, SUN Lei. The 105th Hospital of PLA, Hefei 230000 , China Abstract Objective: To compare the efficacy of hydration combined with 60 mg / day or 40 mg / day atorvastatin on prevention of contrastinduced nephropathy ( CIN) after percutaneous coronary intervention ( PCI) in patients with acute myocardial infarction ( AMI) . Methods: 172 AMI patients were randomly divided into high dose group ( 88 cases ) and low dose group ( 84 cases) . Based on the conventional treatment of PCI,the patients in high dose group after admission to 72 h after PCI were given 60 mg / day atorvastatin orally,and those in low dose group given 40 mg / day atorvastatin orally,at the same time two groups in the perioperative period were given intravenous saline water treatment. The operation associated indexes, variations on biological markers and renal function before and after operation were recorded,and the incidence of CIN and clinical adverse events were noted and compared between the two groups. Results: There was no significant differen



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