循证医学进展预防对比剂肾病指南和专家共识.pptxVIP

CIN---The 3rd tough PCI problem in high risk patients More complicated procedure, More consumption of CM, higher risk in complex PCICIN became the 3rd tough problem in PCI following restenosis and stent thrombosisUtilization of CM reasonable to prevent CIN对比剂肾病 (CIN)CIN的发生率取决于其定义1CIN常用定义为 –血清肌酐值SCr升高 ?44.2 μmol/l (0.5 mg/dl) 和/或48-72小时内升高 ?25%2与未发生CIN的患者相比， CIN与下列后果有关– 住院时间延长3– 死亡率升高4 1.McCullough PA et al. Am J Med 1997; 103: 368-375.2.Morcos SK et al. Eur Radiol 1999; 9: 1602-1613.3. Gruberg L et al. J Am Coll Cardiol 2000; 36: 1542-1548.4. Levy EM et al. JAMA 1996; 275: 1489-1494.Incidence of CIN3rd most common cause of hospital-acquired renal failure1Important cause of ARF in patients with PCI2CIN incidence up to 50% in high risk pts (with RI DM)31. Nash K et al. Am J Kidney Dis. 2002; 39: 930-936.2. McCullough PA et al. Am J Med 1997; 103: 368-375.3. Manske CL et al. Am J Med. 1990; 89: 615-620.CIN prevention strategy in related international organization clinical guidelineACC/SCAI2001 Clinical Expert Consensus Document on Cardiac Catheterization Laboratory StandardsACR 2002 ACR Practice Guideline for the Use of Intravascular Contrast Media 2003 Practice Guideline for the Performance of Diagnostic Arteriography in AdultsFrench Society of Radiology2004 Prévention de l’insuffisance rénale induite par les produits de contraste iodés2005 Produits de contraste iodés et diabèteACC/AHA/SCAI2005 Guideline Update for Percutaneous Coronary InterventionACC/AHA 2005 Guidelines for the Management of Patients with Peripheral Arterial DiseaseESUR2005 Guidelines on Contrast MediaGerman Cardiac Society2005 Arbeitsanweisung im HKLNKF2005 K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis PatientsACC2006 contrast-induced nephropahty consensus working panel: Executive Summary中国专家对比剂肾病共识工作组的目的综述分析已发表的有关 CIN的原始资料编写基于循证医学证据的共识声明为临床医生提供降低CIN风险的明确策略共识一 在有急性肾衰竭危险的患者中，对比剂肾病（CIN）是对比剂应用后常见、严重的并发症。共识二 在慢性肾脏疾病(CKD)的患者中（尤其合并糖尿病时），CIN的危险性明显增加。共识