pci术后肌酐升高一例李为民PPT课件

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

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

3、 hours44.3mol/ LCIN第6页/共32页CIN 预测因子肾功能损害？高龄 (71Y)糖尿病 (8Y)CHF或围术期血流动力学不稳定（IABP）有效血容量降低贫血对比剂肾病中国专家共识The First Affiliated Hospital of Harbin Medical University第7页/共32页SCrA. 肾功能正常96.3mol/L女 76106 mol/L男 44132 mol/LB. 肾功能异常The First Affiliated Hospital of Harbin Medical UniversityC. 肾功能不一定正常第8页/共32页Scr受多

4、种因素影响年龄性别体重肌肉含量 2020g = 1mgg = 1mg种族The First Affiliated Hospital of Harbin Medical University第9页/共32页GFR (ml/min1.73m2) =175血肌酐-1.154年龄 -0.203女性0.79 (血肌酐:mg/dl；年龄:岁)MDRD MDRD 简化公式简化公式=52.9 ml/min1.73m2SCr 正常肾功能正常=(96.3mol/L)96.3 96.3 mol/L第10页/共32页肾功能损害高龄 (71Y)糖尿病 (8Y)CHF或围术期血流动力学不稳定（IABP）有效血容量降低贫血

5、对比剂肾病中国专家共识The First Affiliated Hospital of Harbin Medical UniversityCIN 预测因子第11页/共32页 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 预测因子第12页/共32页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页/共32页如何防治CIN? ?A. 水化B. 等渗造影剂C. 造影剂限量D. 速尿E. A+B+CThe First Affiliated Hospital of Harbin Medical University第16页/共32页计算GFR（评估CIN风险）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页/共32页71Y