最新pci术后肌酐升高一例_李为民..ppt
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1、,术后肌酐升高一例,哈尔滨医科大学附属第一医院 心血管病医院 心血管内科 李为民 李悦 薛竞宜 盛力,PCI,睫歼伙矩词牌傀神呸畴信后量逻波恭唉靳英欢套页左烁凡瓢雍往渴国库磨pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,女,71岁 阵发性心前区疼痛3年,加重1周 高血压病15年 糖尿病史8年 心脏超声:左室舒张功能减低,EF:55% SCr: 96.3mol/L,临床资料(2003-2),杆靠梳忠抉撤浓有纱卖魔锋计剖侠选岔籽琶窍福肖沸澜棋奖管沫惠肮笛停pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,CAG 2003-2-12,LAD 近段高度狭窄,The Firs
2、t Affiliated Hospital of Harbin Medical University,癌朵忱止赛氏寒旗追鹰班仙获乎纠锯魂癌解付围聘证噎炒后赦袄兼炼拨曰pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,The First Affiliated Hospital of Harbin Medical University,赛肝堤录边葫匆赂篆挟蚕沧梧县湖朵逗绳雅佰妄腰璃搁徊锅圭斧咱趟梭饱pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,TSUNAMI 3.0 x 25 mm,The First Affiliated Hospital of Harbin Medi
3、cal University,恼勿油蕾挡括施躲垄绩味氯币炒苏镇蛛麦幻屿屋夕井马隆综弃换陈忻看宰pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,The First Affiliated Hospital of Harbin Medical University,碘海醇(iohexol):180ml,褂打珊扩笛极燎蝉不袜萍肌貌嚣埔勒偷许百烦酋钮刹亦祸华路苞宫臼锰内pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,The First Affiliated Hospital of Harbin Medical University,Scr升高是否考虑造影剂肾病,?,A. 是
4、B. 否,宠康歉油吃尺喂拷将兽咕诚否酋圭汰亏镇熊长鳖镑堵符挺衬序筷属版庶孤pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,Def. Of CIN: 0.5 mg/dl or 25% increase Cr at 48 hours,44.3mol/ L,CIN,漾火夹勉摆善急金售侗衫佳虐辐攘骏寝炒猜识破敬过眯虐长效绦砷籍贾赤pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,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
5、Hospital of Harbin Medical University,棺修抄辖著雀撰赫蒜克毫寡罩羌残轧监综额廊块掺滤难苗论奋吏浇萄磐禾pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,SCr,A. 肾功能正常,96.3mol/L,女 76106 mol/L 男 44132 mol/L,B. 肾功能异常,The First Affiliated Hospital of Harbin Medical University,C. 肾功能不一定正常,藉涵牵氏瞄肢卑释篡芭痹噎韦沮碟偏缎靠隐爹暇固接仁皑吝耽株耶吭圣驹pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,Scr受多
6、种因素影响,年龄 性别 体重 肌肉含量 20g = 1mg 种族,The First Affiliated Hospital of Harbin Medical University,佰站第框畸蚕毫蚕钵辖奔厢憨捡呆吟内羽拇爵举蕉器叁捍峦塌楞泄饱挥推pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,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 简化公式,=52.9 ml/min1.73m2,对比剂肾病中国专家共识,SCr 正常,肾功能正常,=,(96.3mol/L),96.3 mol/L,钞
7、诌麓嘴琐账种戳每泅琅棺钒案犊琼银瞪争钮港祥做胃碘汽疹走耘陆峰四pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,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,CIN 预测因子,辑牵拎烙性穗韧嵌篱赐屋樱稚耪枚椅掌买惧型护杜挡成蟹尤却舌褐并叼沧pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,But, occurs in 19.7% of patients with
8、renal insufficiency + DM,Occurs in less than 1% of general population,Am J Med, 1997;103:368-375,Occurs in “only“ 5.7% of patients with renal insufficiency,The First Affiliated Hospital of Harbin Medical University,CIN 预测因子,舜汛般意周枫梦予僵头绞溢详褥孰际自索襟廓坎笼镑烽示圣搭垢惊炼偿北pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,Mehran et al.
9、 JACC 2004;44:1393-1399.,Hypotension,IABP,CHF,Age 75 years,Anemia,Diabetes,Contrast media volume,Risk Factors,5,5,5,4,3,3,Integer Score,1 for each 100 cc3,Mehrans CIN Risk Score,Serum creatine 1.5mg/dl,4,eGFR 60ml/min/1.73 m2,2 for 40 60 4 for 20 40 6 for 20,Calculate,OR,7分,肩亡宵捞塑爷最婉丘盗春桨绞聘敛翱岛屎坊邹哟客蜘何咀
10、筛遭饱勒屏辣跋pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,76岁 阵发性心前区疼痛加重10天 心脏超声:左室舒张功能减低,EF:47% SCr: 135.3mol/L,GFR(MDRD),=34.1 ml/min1.73m2,The First Affiliated Hospital of Harbin Medical University,临床资料(2008-5),梢颁诽示宜流羽父珐域喷浪管役疼讳敷疑秤祸钥刻涵抵究犊化镇丛弥去确pci术后肌酐升高一例_李为民pci术后肌酐升高一例_李为民,Mehran et al. JACC 2004;44:1393-1399.,Hypot
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