慢性肾病患者在进行急诊心脏手术时经脉注射碳酸氢钠预防造影剂肾病

Prevention of Contrast-Induced Nephropathy by Bolus Injection of Sodium Bicarbonate in Patients With Chronic Kidney Disease Undergoing Emergent Coronary Procedures

慢性肾病患者在进行急诊心脏手术时经脉注射碳酸氢钠预防造影剂肾病海南医学院附属医院内分泌科王新军

We conducted a prospective study to determine whether a bolus injection of sodium bicarbonate before emergent coronary procedures in patients with chronic kidney disease (CKD) might prevent contrast-induced nephropathy (CIN).

为确定慢性肾脏疾病患者急诊冠状动脉手术前推注碳酸氢钠是否可能会阻止造影剂肾病（CIN），我们进行了一项前瞻性研究。

We enrolled 59 patients with CKD, defined by a serum creatinine concentration of >1.1 mg/dl or an estimated glomerular filtration rate of <60 ml/min, who were scheduled at admission to undergo an emergent coronary procedure. The patients were randomized to receive a bolus intravenous injection of 154 mEq/L of sodium bicarbonate (n = 30) or sodium chloride (n = 29) at the dose of 0.5 ml/kg, before contrast administration, followed by infusion of 154 mEq/L sodium bicarbonate at 1 ml/kg/hour for 6 hours in both groups.

我们共招募了59例慢性肾脏疾病的患者，慢性肾脏疾病的定义是血清肌酐浓度> 1.1 mg / dl或估计肾小球滤过率<60 ml/min，这些患者均入院接受急症冠状动脉手术。在给予造影剂前，患者分别接受154 mEq/L的碳酸氢钠（30例）或生理盐水（29例）静脉注射，剂量为0.5 ml/kg，随后两组均以1 ml/kg/hour给予154 mEq/L的碳酸氢钠6小时。25% or >0.5 mg/dl of the serum creatinine level within 2 days after the procedure." onmouseout="this.style.backgroundColor="#fff"">

The primary end point was the occurrence of CIN, defined as an increase by >25% or >0.5 mg/dl of the serum creatinine level within 2 days after the procedure.  In the sodium bicarbonate group, the serum creatinine concentration remained unchanged within 2 days of contrast administration (from 1.32 ± 0.46 to 1.38 ± 0.60 mg/dl, p = 0.33). In contrast, it had increased in the sodium chloride group (1.51 ± 0.59 to 1.91 ± 1.19 mg/dl, p = 0.006). The incidence of CIN was significantly lower in the sodium bicarbonate group than in the sodium chloride group (3.3% vs 27.6%, p = 0.01). In conclusion, rapid alkalization by bolus injection of sodium bicarbonate was effective for the prevention of CIN in patients with CKD undergoing emergent procedures.

主要终点为CIN的发生，其定义是血肌酐水平在手术后2天内增加> 25％或>0.5 mg/dl。在碳酸氢钠组，血清肌酐浓度在2天内保持不变（从1.32 ± 0.46 到 1.38 ± 0.60 mg/dl，p= 0.33）。与此相反，氯化钠组有显著增加（1.51 ± 0.59 到 1.91 ± 1.19 mg/dl, p = 0.006）。与氯化钠组相比，碳酸氢钠组CIN的发生率明显降低（3.3％ vs 27.6％，p= 0.01）。总之，通过快速推注碳酸氢钠碱化是防止慢性肾病患者急症手术发生CIN的有效预防方法。

Am J Cardiol 2011.