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目的探讨水化联合前列地尔对老年冠心病患者冠状动脉介入(PCI)术后造影剂肾病(CIN)的预防作用。方法纳入85例拟行PCI的老年冠心病患者,分为3组:对照组22例,水化组28例,水化+前列地尔组35例。对照组仅接受常规冠心病二级预防治疗;水化组在围手术期接受规范的水化疗法;水化+前列地尔组在水化疗法的基础上,于PCI术后3 d连续应用前列地尔注射液静脉滴注。检测患者PCI术前及术后连续3 d的血清肌酐,分析血清肌酐清除率(Ccr),并比较CIN的发生率。结果 (1)PCI术后第3天,水化组与水化+前列地尔组的血清Ccr下降幅度均明显低于对照组,且以水化+前列地尔组的血清Ccr下降幅度最小;(2)PCI术后CIN发病,对照组发生6例(27.3%),水化组发生3例(10.7%),而水化+前列地尔组仅为1例(2.9%),3组间比较差异有统计学意义(P<0.05)。结论针对接受PCI的老年冠心病患者,应用水化疗法联合静脉滴注前列地尔可有效预防CIN,并且其疗效较单纯水化疗法更佳。
Objective To investigate the preventive effect of hydration combined with alprostadil on contrast-induced nephropathy (CIN) after coronary artery intervention (PCI) in elderly patients with coronary heart disease. Methods Eighty-five elderly patients with coronary artery disease undergoing PCI were enrolled and divided into three groups: control group (n = 22), hydration group (n = 28) and hydration + prostaglandin group (n = 35). The control group received routine secondary prevention of coronary heart disease. The hydration group received standard hydration therapy during perioperative period. The hydration + alprostadil group received the top three consecutive days after PCI on the basis of hydration therapy Deer injection intravenous drip. Serum creatinine was measured before PCI and after PCI for 3 consecutive days. Serum creatinine clearance (Ccr) was analyzed and the incidence of CIN was compared. Results (1) On the third day after PCI, the decrease of serum Ccr in hydration group and hydration + alprostadil group was significantly lower than that in control group, and the decrease of serum Ccr in hydration + alprostadil group was the smallest; (2) The incidence of CIN after PCI was 6 cases (27.3%) in control group, 3 cases (10.7%) in hydration group and only 1 case (2.9%) in hydration plus alprostadil group The difference was statistically significant (P <0.05). Conclusions For patients with coronary heart disease undergoing PCI, the combination of hydration therapy and intravenous infusion of alprostadil can effectively prevent CIN, and its efficacy is better than that of pure hydration therapy.