pci术后肌酐升高一例李为民PPT.ppt

Cypher select 2.75x28mm The First Affiliated Hospital of Harbin Medical University 碘克沙醇(iodixanol): 210ml The First Affiliated Hospital of Harbin Medical University 2008-5-6 术前 2008-5-8 术后一天 2008-5-9 术后三天 2008-5-15 术后一周 2008-6-7 术后一月 SCr ?mol/L 135.3 147.2 163.1 141.7 132.8 ΔSCr ?mol/L 11.9 27.8 5.4 -2.5 Def. Of CIN: 0.5 mg/dl or 25% increase Cr at 48 hours CIN × The First Affiliated Hospital of Harbin Medical University 71Y；GFR： 52.9 ml/min；DM 碘海醇 CIN 水化、碱化 碘克沙醇 他汀 CIN × 5Y 风险评估 + 有效措施 (180ml) (210ml) 76Y；GFR： 34.1 ml/min；DM * 术后肌酐升高一例 哈尔滨医科大学附属第一医院 心血管病医院 心血管内科 李为民 李悦 薛竞宜 盛力 PCI 女，71岁 阵发性心前区疼痛3年，加重1周 高血压病15年 糖尿病史8年 心脏超声：左室舒张功能减低，EF：55% SCr： 96.3?mol/L 临床资料（2003-2） CAG 2003-2-12 LAD 近段高度狭窄 The First Affiliated Hospital of Harbin Medical University The First Affiliated Hospital of Harbin Medical University TSUNAMI 3.0 x 25 mm The First Affiliated Hospital of Harbin Medical University Def. Of CIN: 0.5 mg/dl or 25% increase Cr at 48 hours 44.3μmol/ L CIN √ CIN 预测因子 肾功能损害？ 高龄 (71Y) 糖尿病 (8Y) CHF或围术期血流动力学不稳定（IABP） 有效血容量降低 贫血 《对比剂肾病中国专家共识》 The First Affiliated Hospital of Harbin Medical University SCr A. 肾功能正常 96.3?mol/L 女 76～106 ?mol/L 男 44～132 ?mol/L B. 肾功能异常 The First Affiliated Hospital of Harbin Medical University C. 肾功能不一定正常 Scr受多种因素影响 年龄 性别 体重 肌肉含量 20g = 1mg 种族 The First Affiliated Hospital of Harbin Medical University GFR (ml/min·1.73m2) =175×血肌酐-1.154×年龄 -0.203×[女性×0.79] (血肌酐:mg/dl；年龄:岁) MDRD 简化公式 =52.9 ml/min·1.73m2 《对比剂肾病中国专家共识》 SCr 正常 肾功能正常 = (96.3?mol/L) 96.3 ?mol/L 肾功能损害 高龄 (71Y) 糖尿病 (8Y) CHF或围术期血流动力学不稳定（IABP） 有效血容量降低 贫血 《对比剂肾病中国专家共识》 The First Affiliated Hospital of Harbin Medical University CIN 预测因子 But, occurs in 19.7% of patients with renal insufficiency + DM Occurs in less than 1% of general population Am J Med, 1997;103:368-375 Occurs in only 5.7% of patients with renal