Service de cardiologie D, hôpital cardiovasculaire et pneumologique Louis-Pradel, groupement hospitalier Est, université Claude-Bernard Lyon-1, avenue Doyen-Lepine, Bron cedex, France.
Arch Cardiovasc Dis. 2009 Nov;102(11):761-7. doi: 10.1016/j.acvd.2009.07.001. Epub 2009 Oct 15.
Infusion of saline attenuates the decrease in renal function induced by radiographic contrast agents among patients with chronic renal insufficiency.
The Preventing Renal alteration in Coronary Disease (PRECORD) trial was a randomized trial to assess the effect on renal function of saline infusion during and after coronary angiography in 201 patients without severe chronic renal insufficiency (serum creatinine<140micromol/L).
All patients received standard oral hydration: 2000mL of tap water within the 24 hours after coronary angiography. Patients were randomized before the procedure to intravenous hydration (1000mL of 0.9% saline infusion) or no additional hydration. The infusion was started in the catheterization laboratory and continued for 24 hours. The primary endpoint was the change in calculated creatinine clearance between baseline and 24 hours after coronary angiography. The same ionic low osmolar radiographic contrast agent (ioxaglate) was used in all patients.
Both groups had similar baseline characteristics, including age, serum creatinine, volume of contrast and proportion of patients undergoing ad hoc coronary angioplasty. The overall decrease in serum creatinine clearance 24 hours after the procedure was -3.44 (0.68)mL/min. The change in serum creatinine clearance 24 hours after the procedure was -2.81 (1.07)mL/min in the infusion group vs -4.09 (0.91)mL/min in the control group (p=0.38).
Renal function is altered only slightly 24 hours after coronary angiography with standard oral hydration alone and is not affected by saline infusion started at the beginning of coronary angiography, even in patients with mild-to-moderate renal dysfunction.
在慢性肾功能不全患者中，输注生理盐水可减轻造影剂引起的肾功能下降。
预防性冠状动脉造影（PRECORD）试验是一项随机试验，旨在评估 201 例无严重慢性肾功能不全（血清肌酐<140μmol/L）患者在冠状动脉造影期间和之后输注生理盐水对肾功能的影响。
所有患者均接受标准口服水化治疗：冠状动脉造影后 24 小时内口服 2000mL 自来水。患者在操作前随机分为静脉水化组（1000mL 0.9%生理盐水输注）或不进行额外水化组。输液在导管室开始，持续 24 小时。主要终点是冠状动脉造影后 24 小时计算的肌酐清除率的变化。所有患者均使用相同的离子低渗造影剂（碘海醇）。
两组患者的基线特征相似，包括年龄、血清肌酐、造影剂用量和接受择期冠状动脉成形术的患者比例。术后 24 小时血清肌酐清除率总体下降 3.44（0.68）mL/min。输液组术后 24 小时血清肌酐清除率变化为-2.81（1.07）mL/min，对照组为-4.09（0.91）mL/min（p=0.38）。
单独标准口服水化治疗后，仅轻微改变肾功能，且即使在轻度至中度肾功能不全患者中，也不会因冠状动脉造影开始时开始输注生理盐水而改变。
