【摘要】 目的比较口服N-乙酰半胱氨酸(NAC)联合碳酸氢钠水化或联合0.9%氯化钠注射液水化在预防非糖尿病患者行冠脉或周围血管介入操作后造影剂肾病(CIN)的疗效。方法 120例非糖尿病患者随机分为碳酸氢钠水化组(SB组,n=62)及0.9%氯化钠注射液水化组(NS组,n=58)。SB组行介入操作前应用1.5%碳酸氢钠溶液水化,NS组应用0.9%氯化钠注射液水化,两组患者均在操作前一天及操作当日服用NAC 1 200 mg,bid。两组患者在年龄、性别、体质量指数、血压、血清肌酐(SCr)、电解质、动脉血pH和造影剂剂量上无差异。检测操作前、操作后48,72 h SCr浓度,所有患者均使用低渗非离子型造影剂,主要研究终点为CIN。结果 SB组出现CIN 2例(3.23%),NS组8例(13.79%),SB组CIN发病率低于NS组(P<0.05)。结论口服NAC联合碳酸氢钠水化在预防非糖尿病患者CIN发生的作用可能优于NAC联合0.9%氯化钠注射液水化。更多还原

【Abstract】 Objective To compare the clinical effect of orally administered N-acetylcysteine( NAC) combined with intravenous sodium bicarbonate or combined with intravenous saline in preventing contrast-induced nephropathy( CIN) in patients without diabetes mellitus after coronary or peripheral angiography. Methods One hundred and twenty patients were randomly assigned to receive oral NAC combined with intravenous 1. 5% sodium bicarbonate( SB group,62 patients) or oral NAC combined with intravenous normal saline( NS group,58 patients) before angiography. NAC was given at the dose of 1 200 mg bid on the day of and the day before angiography. There were no significant differences in age,sex,BMI,hypertension,Scr,serum electrolytes,arterial blood gas or contrast volume between the two groups. Scr was assessed right before and 48 and 72 hours after contrast administration. All patients received administration of hypotonic nonionic contrast. The primary endpoint was CIN. Results CIN developed in 2 patients( 3. 23%) in the SB group and in 8 patients( 13. 79%) in the NS group. The incidence of CIN was significantly lower in the SB group as compared with the NS group( P < 0. 05). Conclusion Oral NAC combined with intravenous sodium bicarbonate may be superior to oral NAC combined with intravenous saline in preventing CIN in patients without diabetes mellitus undergoing coronary or peripheral angiography.更多还原