pci術(shù)后肌酐升高一例李為民PPT課件

1、CAG 2003-2-12LAD LAD 近段高度狹窄The First Affiliated Hospital of Harbin Medical University第1頁/共32頁The First Affiliated Hospital of Harbin Medical University第2頁/共32頁TSUNAMI TSUNAMI 3.0 x 25 mmThe First Affiliated Hospital of Harbin Medical University第3頁/共32頁The First Affiliated Hospital of Harbin Medical

2、University碘海醇碘海醇(iohexol):180ml第4頁/共32頁2003-2-11 術(shù)前2003-2-13術(shù)后一天2003-2-14術(shù)后二天2003-2-20術(shù)后一周2003-3-12術(shù)后一月SCr mol/L96.3 146.6241.2160.8103.8 SCr mol/L49.3134.963.57.5The First Affiliated Hospital of Harbin Medical UniversityScr升高是否考慮造影劑腎病?A. 是 B. 否第5頁/共32頁Def. Of CIN: 0.5 mg/dl or 25% increase Cr at 48

3、 hours44.3mol/ LCIN第6頁/共32頁CIN 預(yù)測因子腎功能損害？高齡 (71Y)糖尿病 (8Y)CHF或圍術(shù)期血流動力學(xué)不穩(wěn)定（IABP）有效血容量降低貧血對比劑腎病中國專家共識The First Affiliated Hospital of Harbin Medical University第7頁/共32頁SCrA. 腎功能正常96.3mol/L女 76106 mol/L男 44132 mol/LB. 腎功能異常The First Affiliated Hospital of Harbin Medical UniversityC. 腎功能不一定正常第8頁/共32頁Scr受多

4、種因素影響年齡性別體重肌肉含量 2020g = 1mgg = 1mg種族The First Affiliated Hospital of Harbin Medical University第9頁/共32頁GFR (ml/min1.73m2) =175血肌酐-1.154年齡 -0.203女性0.79 (血肌酐:mg/dl；年齡:歲)MDRD MDRD 簡化公式簡化公式=52.9 ml/min1.73m2SCr 正常腎功能正常=(96.3mol/L)96.3 96.3 mol/L第10頁/共32頁腎功能損害高齡 (71Y)糖尿病 (8Y)CHF或圍術(shù)期血流動力學(xué)不穩(wěn)定（IABP）有效血容量降低貧血

5、對比劑腎病中國專家共識The First Affiliated Hospital of Harbin Medical UniversityCIN 預(yù)測因子第11頁/共32頁 But, occurs in 19.7% of patients with renal insufficiency + DM Occurs in less than 1% of general population Occurs in only 5.7% of patients with renal insufficiencyThe First Affiliated Hospital of Harbin Medical U

6、niversityCIN 預(yù)測因子第12頁/共32頁RiskScoreRiskof CINRisk ofDialysis 57.5%0.04%6 to 1014.0%0.12%11 to 1626.1%1.09% 1657.3%12.6%Mehran et al. JACC 2004;44:1393-1399.HypotensionIABPCHFAge 75 yearsAnemiaDiabetesContrast media volumeRisk Factors555433Integer Score1 for each 100 cc3Mehrans CIN Risk ScoreSerum cr

7、eatine 1.5mg/dl4eGFR 60ml/min/1.73 m22 for 40 604 for 20 406 for 75 yearsAnemiaDiabetesContrast media volumeRisk Factors555433Integer Score1 for each 100 cc3Mehrans CIN Risk ScoreSerum creatine 1.5mg/dl4eGFR 60ml/min/1.73 m22 for 40 604 for 20 406 for 20CalculateOR13分第15頁/共32頁如何防治CIN? ?A. 水化B. 等滲造影劑C. 造影劑限量D. 速尿E. A+B+CThe First Affiliated Hospital of Harbin Medical University第16頁/共32頁計算GFR（評估CIN風(fēng)險）3059mL/min60mL/min0.5 mg/dl0.5 mg/dl or or 25%25% increase Cr at 48 hours increase Cr at 48 hoursCINThe First Affiliated Hospital of Harbin Medical University第29頁/共32頁71Y