多支病變伴腎功能不全的介入治療魏盟

1、多支病變伴多支病變伴腎功能不全的腎功能不全的介入治療介入治療病史男性，68歲，活動后胸悶一月一年前因穩(wěn)定型心絞痛行PCI （LAD和RCA，Cypher)，術(shù)后半年不規(guī)則服藥，2月前停藥；高血壓病、慢性腎功能不全；血脂控制不佳診斷和處理冠心病，勞累型心絞痛PCI術(shù)后高血壓病3級（極高危）慢性腎功能不全EF=44%Cr=163mol/L（66kg)復(fù)查冠脈造影復(fù)查冠脈造影一年前冠脈造影一年前PCIRCA: Cypher 3.5*23mm Cypher 2.75*33mmLAD: Cypher 3.0*23mm 預(yù)防造影劑腎病的預(yù)防造影劑腎病的8 8字訣字訣分層、水化、限量、等滲分層、水化、限量、

2、等滲多支病變腎功能不全多支病變腎功能不全分層“GFR value:39mL/min/1.73m2; The patient has stage 3 CKD”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 S

3、core1 for each 100 cc3造影劑腎病(CIN)風(fēng)險評估Serum creatinine 1.5mg/dl4eGFR 60ml/min/1.73 m22 for 40 604 for 20 406 for 20eGFR 60ml/min/1.73 m2 =186 x (SCr)-1.154 x (Age)-0.203X (0.742 if female) x (1.210 if African American)CalculateOR最大推薦對比劑用量最大推薦對比劑用量 (MRCD)1.MRCD = 5 (ml) X 患者體重患者體重 (kg) / 血清肌酐血清肌酐 (mg/d

4、L) 178mL2.造影劑用量（造影劑用量（cc) Ccr6 215mL3.總量總量75 yearsAnemiaDiabetesContrast media volumeRisk Factors555433Integer Score1 for each 100 cc3造影劑腎病(CIN)風(fēng)險評估Serum creatinine 1.5mg/dl4eGFR 60ml/min/1.73 m22 for 40 604 for 20 406 for 20eGFR 60ml/min/1.73 m2 =186 x (SCr)-1.154 x (Age)-0.203X (0.742 if female) x (1.210 if African American)CalculateOR冠脈造影Stent: Firebird 2.5*33mm 8-14atm 回旋