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OCC 2014:合并肾功能不全患者PCI治疗的风险与对策

2014-06-05 小田 整理 医学论坛网

在5月31日的东方心脏病学会议(OCC 2014),北京医院何青教授介绍了合并肾功能不全患者经皮冠脉介入(PCI)治疗的风险与对策。 对比剂使用时需考虑5类特殊人群,包括慢性肾病(CKD)、急性冠脉综合征(ACS)、慢性心力衰竭(CHF)、糖尿病和高龄老年人群。CIN发生的相关因素为基线肾功能状态、糖尿病、造影剂用量和间隔时间以及其他相关因素等,其中基线肾功能障碍是CIN最关键的独立

在5月31日的东方心脏病学会议(OCC 2014),北京医院何青教授介绍了合并肾功能不全患者经皮冠脉介入(PCI)治疗的风险与对策。


对比剂使用时需考虑5类特殊人群,包括慢性肾病(CKD)、急性冠脉综合征(ACS)、慢性心力衰竭(CHF)、糖尿病和高龄老年人群。CIN发生的相关因素为基线肾功能状态、糖尿病、造影剂用量和间隔时间以及其他相关因素等,其中基线肾功能障碍是CIN最关键的独立预测因子,与患者血清肌酐水平呈正相关。当肌酐水平≤1.2 mg/dl、1.4—1.9 mg/dl和≥2 mg/dl时,CIN风险为分别为2%、 10.4%和62%。糖尿病为合并肾功能障碍时CIN的独立预测因子,无肾功能障碍的糖尿病人群CIN的发生率与非糖尿病人群相似,但伴有肾功能障碍时,肌酐水平>4 mg/dl,CIN发生率达81%。其他危险因素包括高龄(年龄≥75岁)、血管内有效血容量减少(充血性心力衰竭、肝硬化、肾病综合征等)、肾毒性药物(环孢素A、氨基苷类、两性霉素、顺氯胺铂和甾体类抗炎药等)、多发性骨髓瘤、低血压、高血压、贫血、血管紧张素转换酶抑制剂等。

何教授介绍,CIN的治疗以水化为主,对比剂中国共识小组推荐的一种水化方法为从造影前6—12小时至造影后12小时,应用NS iv 1.0—1.5 ml/kg/h,保持尿量75—125 ml/ h。但对心功能不全的患者要注意补液速度,以免加重心力衰竭。

药物治疗包括N-乙酰半胱氨酸、抗氧化剂、他汀类药物和前列腺素E1等,但尚无证据证明上述药物的预防和治疗CIN效果。对于合并心功能不全、尤其是伴有肾功能不全的患者若很难接受水化,可考虑造影后尽快实施连续血液净化来清除对比剂,预防CIN。

何教授强调,CIN重在预防。对合并肾功能不全患者行PCI时,应牢记四项“避免”措施,即避免使用高渗对比剂,避免使用大剂量对比剂,避免使用甘露醇和利尿剂,避免短时内多次使用对比剂。在对比剂的选择上,美国指南提出低渗对比剂和等渗对比剂的肾脏安全性无差异,故不再对慢性肾脏病患者使用含碘对比剂时选择何种对比剂进行推荐。我国专家共识认为,患者如需行冠脉造影或PCI术,低渗对比剂和等渗对比剂均可使用;同时应控制对比剂剂量,对于肾功能不全者,冠脉造影和PCI时对比剂用量应更为严格。在肌酐清除率<60 ml/min的慢性肾病患者,对比剂的使用剂量应最小化,也可参考Cigarroa计算公式:5ml*体重(kg)/Cr(mg/dl)。

对比剂分类



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    2014-10-15 yese
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    2014-06-07 zhaojie88

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5月30日上午,南京医科大学第一附属医院心内科的陈明龙教授在国际厅就希氏束旁起源的特发性室速的标测与消融进行了系统介绍。  陈教授首先介绍了His及邻近区域解剖,他将传导系统比作一颗倒生长的树。希氏束旁起源的室早/室速解剖分为右侧希氏束旁和左侧希氏束旁起源。右侧希氏束旁的室早/室速的多来源于心肌,而左侧希氏束旁的室早/室速多起源于希蒲系统。陈教授接下来阐述了希氏束旁起源的室早/室速

OCC 2014:动脉粥样硬化相关科研基金申请的注意事项

2014年5月30日,由陈桢玥教授,梁春教授主持,荆清教授主讲的“动脉粥样硬化相关科研基金申请的注意事项”在上海国际会议中心举行。本次讲座主要围绕着国家自然科学基金项目申请准备,撰写项目申请书及注意事项以及申请及评审程序这三个方面进行展开。 首先荆教授简略介绍了下各资助项目的类型资助额度以及资助年限,其中重点介绍了“血管稳态与重构的调控机制”这个项目,荆教授认为该项目资助力度近期得到增强,值得重

OCC 2014:怎样从文献阅读中找到SCI的灵感

2014年5月30日,由荆清教授,梁春教授主持,胡凯教授主讲的“怎样从文献阅读中找到SCI的灵感报告”在上海国际会议中心举行。 胡教授首先从选题开始讲起,鼓励大家扩大阅读面以获得更多的研究方向及思路,其阅读面要同时包括中外的文献,报刊等。接着胡教授列举了几分文献,通过例子给参会者演示了如何从例子中通过对结局的分析,对暴露或是风险因素的分析以及对研究收录患者的基本信息如个人行为等找到进一步研究的方

OCC 2014:陈纪言教授介绍CTO介入治疗现状与挑战

5月30日上海国际会议中心世纪厅,来自广东省人民医院的陈纪言教授做了题为“CTO介入治疗现状与挑战”的汇报讲座。 陈纪言教授介绍了目前慢性完全闭塞冠状动脉病变(CTO)治疗的现状,他指出,CTO是一个比较困难的介入治疗疾病,该疾病比较常见,约占总体PCI的10%~15%,但是它是介入治疗中最后一个没有攻克的堡垒,介入成功率仅有50%~80%。但是通过近十年的努力,CTO的治疗有了很大的突破。导丝

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