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目的探讨围术期联合应用阿魏酸钠及氨茶碱对糖尿病患者应用对比剂后的肾功能保护作用。方法将186例行冠状动脉介入诊断与治疗的患者随机分为A组:阿魏酸钠及氨茶碱联合治疗组;B组:氨茶碱治疗组;C组:常规对照组。在全部采用水化治疗的基础上,A组术前24 h及术后5 d氨茶碱0.25g及阿魏酸钠0.3 g静脉滴注每日1次;B组术前24 h及术后5 d氨茶碱0.25 g静脉滴注每日1次;C组为常规治疗对照。分别于术前及术后3 d时检测,对比分析血浆脂质过氧化物丙二醛(MDA)、肾小球滤过滤(GFR)、尿β-2微球蛋白(β-2P)及24 h尿液一氧化氮(NO)含量变化情况。结果术前各组患者MDA、GFR、尿β-2P、24 h尿液NO含量等值无统计学差异。术后3 d,B、C组血浆MDA水平均较术前增高,A组则无统计学差异;GFR与术前相比,三组水平均有降低,B组及C组明显低于A组;尿β-2P术后三组均有升高,A、B组低于C组;术后三组24 h尿NO排出量均有减少,A、B组术后尿NO排出量多于对照组。结论围术期阿魏酸钠及氨茶碱联合静点可以保护糖尿病患者肾功能,减少对比剂肾病的发生。
Objective To investigate the protective effect of perioperative combination of sodium ferulate and aminophylline on diabetic patients with contrast agent. Methods A total of 186 patients undergoing coronary artery interventional diagnosis and treatment were randomly divided into group A: sodium ferulate and aminophylline group; group B: aminophylline group; group C: conventional control group. On the basis of all hydration therapy, group A was given intravenous infusion of 0.25g aminophylline and 0.3g sodium ferulate daily for 24 hours before operation and 5 days after operation, 5 d aminophylline 0.25 g intravenously once a day; C group for routine treatment control. The levels of plasma lipid peroxides such as malondialdehyde (MDA), glomerular filtration (GFR), urinary β-2 microglobulin (β-2P) and 24 h urinary nitric oxide (NO) content changes. Results There was no significant difference in the contents of MDA, GFR, urine β-2P and 24 h urinary NO before operation in each group. At 3 days after operation, the levels of plasma MDA in group B and group C were higher than those in group A, but there was no significant difference in group A. GFR was significantly lower in group B than in group B ; Urinary β-2P after surgery were increased in all three groups, A, B group was lower than C group; postoperative 24-hour urinary NO excretion decreased, A, B group postoperative urinary NO excretion more than the control group. Conclusion Perioperative combination of sodium ferulate and aminophylline can protect renal function of diabetic patients and reduce the incidence of contrast-induced nephropathy.