造影剂肾病课件.pptVIP

谢 谢！ * 对比剂AKI的病理生理学学说 由于肾单位量减少，残留的肾单位易受到损伤，碘对比剂在导致短暂（几分钟）的血管舒张后，会导致持续的（几小时或几天）肾脏内血管收缩和缺血性损伤。缺血性损伤会导致氧化应激，从而产生一系列不良反应，导致肾小管细胞死亡。如果有足够量的肾单位损伤，就会发生血清肌酐显著升高。 * * * The incidence of both mortality and ESRD increased in a graded manner with greater severity of AKI (P for trend 0.001 for both outcomes). The cumulative incidence of all-cause hospitalization exceeded 40% regardless of AKI status and did not increase in a graded manner with greater severity of AKI (P for trend0.137). * * In patients with chronic renal insuf?ciency, further decline in renal function (DRF) after percutaneous coronary intervention (PCI) is accompanied not only by adverse in-hospital events but also by increased risk of mortality and myocardial infarction at 1 year. This analysis was undertaken to determine if patients with normal renal function who develop DRF after PCI have a comparable increase in risk of death and myocardial infarction at 1 year, and whether this risk is independent of in-hospital complications (death, myocardial infarction, urgent coronary artery bypass grafting). We performed a retrospective analysis of all patients from a single center who underwent successful PCI with no major in-hospital complications who had pre-PCI serum creatinine (SCr) ≤ 1.2 mg/dl and no history of renal insuf?ciency. One-year follow-up was obtained by mail or telephone. There were 5,967 consecutive patients who met the inclusion criteria. Of these, 208(3.5%) developed DRF (an increase in SCr ≥ 50% of baseline). They were more likely to be older, female, non-Caucasian, diabetic and/or hypertensive. They reported more prior cerebral or peripheral vascular events. They had undergone more complex PCI and were exposed to more radiographic contrast than the 96.5% who did not develop DRF. After adjustment for baseline variables, DRF remained an independent predictor of 1-year mortality, myocardial infarction, and target vessel revascularization. In patients without prior renal impairment, DRF post-PCI