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Circulation：STEMI病人PCI术前应用山莨菪碱或预防造影剂肾病

2012-04-27 范振光 医学论坛网

CINPCI山莨菪碱
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    我国河北医科大学附属第二医院研究人员在2012年世界心脏病学大会上报告的一项研究显示：ST段抬高型心肌梗死(STEMI)病人直接经皮冠状动脉介入(PCI)术前静脉输注山莨菪碱，有可能预防造影剂肾病(CIN)的发生。       CIN是PCI术后最严重的并发症之一。接受直接PCI的急性心肌梗死病人发生CIN的风险较大。山莨菪碱是从中草药

    我国河北医科大学附属第二医院研究人员在2012年世界心脏病学大会上报告的一项研究显示：ST段抬高型心肌梗死(STEMI)病人直接经皮冠状动脉介入(PCI)术前静脉输注山莨菪碱，有可能预防造影剂肾病(CIN)的发生。
 
    CIN是PCI术后最严重的并发症之一。接受直接PCI的急性心肌梗死病人发生CIN的风险较大。山莨菪碱是从中草药中提取的一种生物碱，广泛用于治疗感染性休克、急性肾小球肾炎和糖尿病性肾病，临床证明山莨菪碱对肾功能有保护作用。该研究旨在研究山莨菪碱对行直接PCI的STEMI病人是否有CIN预防作用。
 
    研究人员将连续行直接PCI的病人随机分为2组：山莨菪碱组（ANI组，在PCI前30分钟内静脉输注山莨菪碱（每分钟3-4μg/kg）；对照组（CON组）静脉输注相同体积的等张盐水(0.9%)。PCI术后全部病人静脉输注等张盐水12小时。病人住院时，PCI术后24、48和72小时测量血清肌酐(SCr)浓度。
共126例病人完成研究，其中ANI组60例，CON组66例。PCI术后2组病人的SCr浓度显著升高，术后48小时达峰值（2组P值均《0.0001），然后开始下降。术后72小时ANI组病人的SCr浓度显著降低(P＜0.0001)，恢复至基线水平(P＞0.05)。术后72小时CON组病人的SCr浓度也显著降低(P＜0.0001)，但仍高于基线水平(P＜0.0001)。PCI术后48和72小时ANI 组病人的SCr浓度较CON组病人低得多(2个P值均＜0.05)。PCI术后估计肾小球滤过率（eGFR）显著降低，48小时降至最低值，然后开始上升。术后72小时ANI组病人的 eGFR显著升高(P＜0.0001)，接近基线水平(P＞0.05)；CON组病人的eGFR也显著升高(P＜0.0001)，但在术后72小时时没有恢复到基线水平(P＜0.0001)。PCI术后24、48和72小时ANI组病人的eGFR较CON组病人高(全部P＜0.05)。PCI术后72小时内，ANI组病人的CIN发生率较CON组低(全部 P＜0.05) 。
 
该摘要于4月15日在线发表于《循环》（Circulation）2012世界心脏病学大会（WCC）口头报告，编号0046。

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    2012-07-04 zxl736

    #PCI术#

    0

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    2012-06-05 1249883fm12暂无昵称

    #山莨菪碱#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1633791, encodeId=15cc1633e914a, content=<a href='/topic/show?id=578d13843ad' target=_blank style='color:#2F92EE;'>#PCI术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13843, encryptionId=578d13843ad, topicName=PCI术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ea4322051797, createdName=zxl736, createdTime=Wed Jul 04 16:07:00 CST 2012, time=2012-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935881, encodeId=298d19358819e, content=<a href='/topic/show?id=9b774e75872' target=_blank style='color:#2F92EE;'>#山莨菪碱#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47758, encryptionId=9b774e75872, topicName=山莨菪碱)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4902500082, createdName=1249883fm12暂无昵称, createdTime=Tue Jun 05 09:07:00 CST 2012, time=2012-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481781, encodeId=68c41481e81e6, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Sun Apr 29 05:07:00 CST 2012, time=2012-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493952, encodeId=9fb31493952e7, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=908d9134595, createdName=sodoo, createdTime=Sun Apr 29 05:07:00 CST 2012, time=2012-04-29, status=1, ipAttribution=)]
    2012-04-29 仁者大医

    #STEM#

    0

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    2012-04-29 sodoo

    #造影#

    0