Kulvatunyou Narong, Rhee Peter M, Carter Steven N, Roberts Pamela M, Lees Jason S, Bender Jeffrey S, Albrecht Roxie M
Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
Am Surg. 2011 Jun;77(6):686-9.
Contrast-induced nephropathy (CIN) in trauma patients is uncommon and the incidence is unknown. We studied the incidence of CIN and its outcome. A retrospective chart review of trauma patients 16 years of age and older who were admitted to our Level I trauma center during 2005 was performed. Patients who received the intravenous contrast CT scan and had their serum creatinine (Cr) monitored at admission and at 48 to 72 hours were identified. CIN was defined as a 0.5-mg/dL rise of serum Cr or a 25 per cent increase from the baseline if the baseline Cr was abnormal. We excluded patients transferred from an outside facility, patients without repeated serum Cr measurements, patients who had cardiac arrest or persistent hypotension, and patients who had received N-acetylcysteine (Mucomyst) before their CT scan. We compared CIN and non-CIN groups. During 2005, 543 fit our study criteria, of whom 19 (3.5%) had CIN. CIN (vs non-CIN) had a higher baseline serum Cr (1.48 + 0.23 vs 1.06 + 0.02, P < 0.001), a longer intensive care unit stay (17 vs 5 days, P < 0.001), and a longer hospital stay (19 vs 8 days, P < 0.001); the mortality rate was not different (10 vs 4%, P = 0.2). We found elevated baseline serum Cr (OR, 1.92; 95% CI, 1.13 to 3.27; P = 0.016) to be associated with increased risk for CIN. All but two serum Cr levels peaked within 48 hours; all returned to baseline. One patient with an underlying congenital kidney disease required temporary dialysis. CIN incidence in trauma is low and the clinical course is benign.
创伤患者中对比剂诱发的肾病（CIN）并不常见，其发病率尚不清楚。我们研究了CIN的发病率及其转归。对2005年期间入住我院一级创伤中心的16岁及以上创伤患者进行了回顾性病历审查。确定接受静脉造影CT扫描并在入院时以及48至72小时监测血清肌酐（Cr）的患者。CIN定义为血清Cr升高0.5mg/dL，或如果基线Cr异常则较基线水平升高25%。我们排除了从外部机构转入的患者、未重复测量血清Cr的患者、发生心脏骤停或持续性低血压的患者以及在CT扫描前接受N-乙酰半胱氨酸（沐舒坦）治疗的患者。我们比较了CIN组和非CIN组。2005年期间，543例符合我们的研究标准，其中19例（3.5%）发生CIN。CIN组（与非CIN组相比）基线血清Cr水平更高（1.48±0.23 vs 1.06±0.02，P<0.001），重症监护病房住院时间更长（17天 vs 5天，P<0.001），住院时间更长（19天 vs 8天，P<0.001）；死亡率无差异（10% vs 4%，P=0.2）。我们发现基线血清Cr升高（比值比，1.92；95%可信区间，1.13至3.27；P=0.016）与CIN风险增加相关。除2例患者外，所有血清Cr水平均在48小时内达到峰值；所有患者均恢复至基线水平。1例患有先天性肾脏疾病的患者需要临时透析。创伤患者中CIN的发病率较低，临床过程呈良性。
