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目的探究在主动脉夹层(Stanford B型)合并肾功能不全患者中行完全血管内超声(intravascular ultrasound,IVUS)介导下主动脉腔内修复术(endovascular aortic repair,EVAR)对减少术后肾功能恶化的意义方法入选2013年2月至2015年6月于广东省人民医院心血管研究所心血管内科拟行EVAR治疗的60例主动脉夹层合并慢性肾功能不全患者,使用随机号码信封法随机分为全IVUS组及对比剂造影组各30例。采集术前、术后肾功能指标,采用χ~2检验或t检验进行两样本单因素分析。结果与使用传统造影剂手术相比,IVUS介导下行EVAR治疗术后患者的肌酐(creatinine,CREA),血尿素氮(blood urea nitrogen,BUN)浓度升高明显更少,差异有统计学意义[24 h IVUS组vs.对比剂组:△CREA为(10.37±21.88)μmol·L~(-1)vs.(28.12±27.69)μmol·L~(-1),P=0.008;ABUN为(2.26±3.84)mmol·L~(-1)vs.(3.37±3.56)mmol·L~(-1),P=0.250;72h IVUS组vs.对比剂组:ACREA为(7.69±23.43)μmol·L~(-1)vs.(34.85±34.01)μmol·L~(-1),P=0.001;△BUN为(2.99±4.71)mmol·L~(-1)vs.(6.07±6.32)mmol·L~(-1),P=0.037]。两组术后CREA、BUN浓度及对比剂肾病发生率比较,差异无统计学意义(P>0.05)。结论 IVUS介导下行EVAR治疗安全有效,并可减少术后肾功能恶化风险。
Objective To investigate the effect of endovascular aortic repair (EVAR) under the condition of complete endovascular ultrasound (IVUS) in patients with aortic dissection (Stanford type B) with renal insufficiency to reduce postoperative renal dysfunction Methods Sixty patients with aortic dissection complicated with chronic renal insufficiency (EVAR) who were enrolled in Department of Cardiology, Guangdong Cardiovascular Institute of Guangdong Provincial People’s Hospital from February 2013 to June 2015 were randomly divided into All IVUS group and contrast agent radiography group of 30 cases. Preoperative and postoperative renal function indexes were collected, and two-sample univariate analysis was performed using χ ~ 2 test or t test. Results The serum creatinine (CREA) and blood urea nitrogen (BUN) concentrations in patients undergoing IVUS-mediated EVAR treatment were significantly lower than those of conventional contrast-enhanced surgery, with statistically significant differences [ 24 h IVUS group vs. contrast group: △ CREA was (10.37 ± 21.88) μmol·L -1 vs. (28.12 ± 27.69) μmol·L -1, P = 0.008; ABUN was (2.26 ± 3.84 mmol·L -1 vs. 3.37 ± 3.56 mmol·L -1, P = 0.250; 72 h IVUS vs. contrast: ACREA was (7.69 ± 23.43) μmol·L -1 (-1) vs. (34.85 ± 34.01) μmol·L -1, P = 0.001 respectively; △ BUN was (2.99 ± 4.71) mmol·L -1 vs. 6.07 ± 6.32 mmol·L -1 L -1, P = 0.037]. The postoperative CREA, BUN concentration and contrast agent nephropathy incidence, the difference was not statistically significant (P> 0.05). Conclusion IVUS-mediated safe and effective treatment of descending EVAR can reduce the risk of postoperative renal dysfunction.