对比剂肾刘志琴 ppt课件.ppt

被忽视的问题 1、ACS患者肾功能情况的调查：在ACS病人中，63.6%的病人存在不同程度的肾功能不全，但临床中自我报告率只有2.51%。 2、高龄、糖尿病、高血压病、既往脑卒中及心肌梗死病史与病人的肾功能状态密切相关。 3、冠脉病变越复杂肾功能受损越重。 * Title or job number * 被忽视的问题----血清肌酐不能反映早期肾功能损害 eGFR, estimated glomerular filtration rate; RI, renal insufficiencyDuncan L et al. Nephrol Dial Transplant 2001;16:1042-1046. 年龄 正常 SCr 异常 eGFR 40-59 Yes 1.2% 60-69 Yes 12.6% ≥70 Yes 47.3% (n=2543) * Title or job number * 个人建议： 1、我们在对预防对比剂肾病的发生方面重视不够，建议科室相关责任人根据“对比剂肾病中国专家共识” 制定我们科目前既方便、又其实可行的具体措施（暂行）。 2、预防CIN的“分层、水化、限量、等渗”的8字方针，目前我们除了无等渗对比剂外，前6字方针应该能够实施。 3、是否申够少量等渗对比剂？ 未雨绸缪 重在预防 * Title or job number * 预防对比剂肾病 任重而道远 如等渗对比剂价贵、意识问题。。。。。。 * Title or job number * 首先，当我们说到CIN时，很多人第一时间都会提起在对比剂肾病风险管理中最权威的机构——欧洲放射协会的泌尿生殖放射协会，而且还有专门的用于CIN风险管理的指南。在指南中，明确提出CIN的定义。 大家可能会问一个问题：CIN的发病率会有多高呢？这里跟大家共同分享一下： Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ; Nephrotoxicity in High-Risk Patients Study of Iso-Osmolar and Low-Osmolar Non-Ionic Contrast Media Study Investigators. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348:491-499. Slide 43: Are We Failing to Identify Patients With RI Because of How We Screen for Them? SCr levels are frequently used to screen for renal dysfunction; however, patients can have significantly decreased GFR with normal range SCr. Duncan et al studied the prevalence of patients who have significantly reduced GFR, as calculated by the Cockcroft-Gault formula, but normal range SCr. Of 2543 outpatients with normal SCr levels, 15.2% had GFR ≤50 mL/min, representing substantially impaired renal function. As patient age increased, the proportion of patients with normal SCr and abnormal GFR increased. In patients ≥70 years old, almost half had renal dysfunction in terms of abnormal GFR, yet normal SCr. Key point: The prevalence of significantly abnormal renal function among patients with normal SCr is substantial. Duncan L, Heathcote J, Djurdjev O, Levin A. Screening for renal dise