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目的对比分析不同连续肾脏替代治疗(CRRT)方法对行经皮冠状动脉介入治疗(PCI)的冠心病合并慢性肾功能不全患者的疗效。方法选择2008年1月—2012年1月在温岭市第一人民医院住院且病历资料完整的行PCI的慢性肾脏疾病(CKD)患者42例,按随机数字表法分为A、B两组,每组21例。A组在行PCI后24 h开始行CRRT;B组在行PCI前8 h及行PCI后24 h均行CRRT。对比两组患者急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、造影剂肾病(CIN)发生率及血肌酐水平。结果两组患者的性别、年龄及入院时APACHEⅡ评分间差异均无统计学意义(P>0.05)。与A组比较,B组患者CIN发生率降低(P<0.05)。A组患者PCI后24 h血肌酐水平高于PCI前(t=2.759,P<0.05),PCI前及PCI后48、72 h血肌酐水平间差异均无统计学意义(t=1.223、0.272,P>0.05);B组患者PCI后24 h血肌酐水平与PCI前间差异无统计学意义(t=0.554,P>0.05),PCI后48、72 h血肌酐水平低于PCI前(t=3.764、2.517,P<0.05)。结论 PCI前、后均行CRRT较仅在PCI后行CRRT能更有效地减少CIN的发生率。
Objective To compare and analyze the effect of different continuous renal replacement therapy (CRRT) on patients with coronary heart disease complicated with chronic renal failure undergoing percutaneous coronary intervention (PCI). Methods Forty-two patients with chronic kidney disease (CKD) who underwent PCI from January 2008 to January 2012 in Wenling First People’s Hospital with complete medical records were divided into A and B groups according to random number table, 21 cases in each group. In group A, CRRT was performed at 24 h after PCI. In group B, CRRT was performed at 8 h before PCI and at 24 h after PCI. The acute physiology and chronic health status score system Ⅱ (APACHEⅡ) score, the incidence of contrast-induced nephropathy (CIN) and serum creatinine were compared between the two groups. Results There was no significant difference in sex, age and APACHEⅡscore between the two groups (P> 0.05). Compared with group A, the incidence of CIN in group B was decreased (P <0.05). Serum creatinine was significantly higher at 24 h after PCI in group A than before PCI (t = 2.759, P <0.05). There was no significant difference in serum creatinine between before PCI and PCI at 48 and 72 h after PCI (t = 1.223, (T = 0.554, P> 0.05). Serum creatinine levels at 48 and 72 h after PCI in group B were significantly lower than those before PCI (t = 3.764, 2.517, P <0.05). Conclusions Both CRRT before and after PCI can reduce the incidence of CIN more effectively than CRRT only after PCI.