摘要
为探讨造影剂对儿童肾功能的不良影响 ,以及水化对造影剂相关性肾病 (CAN)的预防作用 ,将需做静脉肾盂造影或增强CT的30例患儿 ,采用前瞻性随机对照方法 ,随机分为水化组 (HG)和非水化组 (NHG) ,HG于造影后立即给予1/5张含钠维持液20ml/kg ,NHG不予静脉补液。结果显示 ,造影后HG血清肌酐 (Scr) (49.9μmol/L±6.2μmol/L)低于NHG(58.0μmol/L±11.8μmol/L) ,P<0.05 ;而内生肌酐清除率 (Ccr)HG(89.3ml/min±13.2ml/min)明显高于NHG(70.9ml/min±8.8ml/min) ,P<0.05。HG患儿的Scr、Ccr在造影前后差异无显著性 ;虽然NHG患儿造影前后Scr无明显变化(53.1μmol/L±8.0μmol/Lvs58.0μmol/L±11.8μmol/L,P<0.05) ,但Ccr造影后明显降低 (95.9ml/min±14.4ml/minvs70.9ml/min±8.8ml/min,P<0.05)。CAN发病率为16.7 % ,HG无1例发生CAN ,而NHG5/15例发生CAN(33.3% )。其中4例在3天后Scr及Ccr恢复至造影前水平。本研究中基础Scr>61.9μmol/L的3例患儿有2例发生CAN(66.7% )。表明儿童应用碘造影剂后可出现可逆性的CAN ;造影后即刻给予水化可有效地预防CAN的发生 ;儿童Scr>61.9μmol/L时做IVP或增强CT时 。
To explore the influence of iodic contrast medium on renal function and the effect of hydration on the prevention of contrast associated nephropathy (CAN) in children with renal diseases,30 children on whom either intravenous pyelography (IVP) or enhanced CT scan was required were randomly divided into the hydrate group(HG) and the non_ydr_ate group(NHG).1/5 solution at a dose of 20ml/kg was intravenously given immediately after the exposure of contrast me_dium in the HG,while the NHG had not received any infusion.The renal function including serum BUN,creatinine (Scr) and creatinine clearance rate (Ccr) were evaluated before and after the exposure of contrast medium in both groups.The results showed that there were a higher Ccr (89.3±13.2ml/min vs 70.9±8.8ml/min,P<0.05) and lower Scr (49.9±6.2 μmol/L vs 58.0±11.8 μmol/L,P<0.05) in the HG comparing with that in the NHG after the exposure of contrast medium. No significantly changes of Ccr and Scr were observed in the HG before and after the exposure of contrast medium,while in NHG there was an increase of Scr from 53.1±8.0 μmol/L to 58.0±11.8 μmol/L(P<0.05) and a decrease of Ccr from 95.9±14.4ml/min to 70.9±8.8ml/min(P<0.05),respectively.It was noticed that no CAN patient was found in the HG while there were 5 patients in the NHG to develop CAN (33.3%,5/15) although Scr and Ccr were back to original lev_els after three days in 4 cases of them.Furthermore, two of three cases with Scr≥61.9 μmol/L detected before the use ofcontrast medium developed CAN,while just three of 27 cases with Scr<61.9 μmol/L developed CAN. It is concluded that the reversible CAN can occur in children with renal diseases after the exposure of contrast medium.However,CAN can be effectively prevented by the hydration immediately after the use of contrast medium.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2002年第4期205-206,213,共3页
Journal of Clinical Pediatrics
