维生素C预防冠心病合并糖尿病患者发生对比剂肾病的临床疗效研究.docVIP

· 819 · · 论 著 · 维生素C 预防冠心病合并糖尿病患者发生对比剂肾病的 临床疗效研究 周力，陈晖，李虹伟 【摘要】 目的 探讨冠心病合并糖尿病患者应用维生素C 预防对比剂肾病的安全性和临床疗效。方法 本研究 为单中心前瞻性随机对照临床试验，连续入选96例合并糖尿病的冠心病患者，随机分为两组。对照组(n=50) 患者 仅用0.9%氯化钠溶液进行常规水化；干预组 (n=46) 患者在常规水化的基础上于术前2~4h 予3 .0g 维生素C 静脉 滴注，术后第1、2天分别口服1.0g 维生素C (早晚各服0.5g), 静脉滴注及口服的维生素C 总量为5.0g。观察术后 患者的肾功能及心脏不良事件发生情况。 结果 维生素C 干预组对比剂肾病发生率较对照组低，但差异无统计学意义 (6.5% vs 10.0%,P=0.540)。研究期间有1例患者出现支架内亚急性血栓形成，其余患者均未观察到严重的心脏不 良事件。 结论 对于合并糖尿病的冠心病患者短程应用大剂量维生素C 有降低对比剂肾病发生的趋势，但与对照组相 比差异无统计学意义，维生素C 预防对比剂肾病的有效性尚需大样本临床试验来证实。 【关键词】 肾病；对比剂；冠状血管造影术；维生素C 【中图分类号】 R692.9 R541.4 【文献标识码】 A 【文章编号】1007-9572(2010)03-0819-02 Pr evention of Contrast -induced Nephropathy with Ascorbic Acid in Coronary Heart Disease Patients with Diabetes Mel- litus ZHOU Li, CHEN Hui,LI Hong -wei. Cardiovascular Center,Beijing Friendship Hospital, Capital University of Medi- cine,Beijing 100050,China 【Abstract 】 Objective To evaluate the safety and efficacy of ascorbic acid in prevention of contrast -induced nephrop- athy in coronary heart disease(CHD) patients with diabetes mellitus(DM). Methods A single -center prospective random- ized controlled trial was performed, 96 CHD patients with DM were divided randomly into groups control (n=50, receiving only 0.9% sodium chloride solution for routine hydration)and intervention(n=46,based on routine hydration receiving vitamin C intravenous infusion,3.0 g,2～4 h before operation,and oral vitamin C,1.0 g, on day 1,2,respectively,after opera- tion). The total dosage of intravenous and oral vitamin was 5. 0 g. The renal function and the occurrence of adverse cardiac e- vents were observed after operation. Results The incidence of contrast - induced nephropathy was lower in intervention group than in control, but the difference was not significant(6.5% vs 10.0%,P=0.540). No severe adverse cardiac events were noted in all patients during the research except 1 presenting with subacute stent thrombosis. Conclusion