College of Postgraduate, Tianjin Medical University, Tianjin 300070, China.
Chin Med J (Engl). 2011 Dec;124(23):4079-82.
To lessen the occurrence of contrast-induced nephropathy (CIN), the preventive measures of CIN were reviewed.
The data used in this review were from PubMed with relevant English articles and from Chinese Knowledge Information (CNKI) published from 1989 to 2009. The search terms were "contrast medium", "contrast-induced nephropathy" and "prevention". Articles involved in prevention of CIN were selected.
CIN is the third most common cause of acute kidney injury and is associated with an unfavorable prognosis. The best treatment is prophylaxis because CIN can not be reversed or ameliorated.
Thirty articles were included. Among various preventive measures, pericatheterization hydration is almost universally accepted as an appropriate and safe measure to prevent CIN, although there is no agreement as to composition, amount, and timing of hydration. Based on the use of concomitant nephrotoxic agents or high doses of contrast medium (CM) is one of risk factors for CIN, discontinuation of potentially nephrotoxic drugs 2 - 3 days before and after the procedure until renal function recover, and using the lowest possible dose of CM can decrease the risk of CIN. It is promising that removing the majority of CM from the coronary sinus, before it enters the systemic circulation, during coronary angiography can reduce the risk for CIN in animal studies and in limited clinical trials. Inconsistent data exist with respect to application of some vasodilators (endothelin antagonists and adenosine antagonists) and antioxidants (N-acetylcysteine and statins) in preventing CIN in high-risk patients, and new vasodilators and antioxidants continue to be tested.
Pericatheterization hydration, discontinuation of nephrotoxic drugs, and using the lowest possible dose of CM are effective measures to lessen the risk for CIN. Other prophylactic strategies and some drugs are promising, but further confirmation is required.
为了减少对比剂肾病（CIN）的发生，对 CIN 的预防措施进行了综述。
本研究资料来源于 PubMed 中相关的英文文献及 1989 年至 2009 年中国知识资源总库（CNKI）中发表的中文文献，检索词为“contrast medium”“contrast-induced nephropathy”和“prevention”。选择涉及 CIN 预防的文章。
CIN 是急性肾损伤的第三大常见原因，与不良预后相关。最好的治疗方法是预防，因为 CIN 无法逆转或改善。
共纳入 30 篇文章。在各种预防措施中，经皮导管水化几乎被普遍认为是预防 CIN 的一种适当且安全的措施，尽管对于水化的组成、量和时间尚未达成共识。基于使用伴随的肾毒性药物或大剂量对比剂（CM）是 CIN 的一个危险因素，在操作前后 2-3 天停用潜在肾毒性药物，并且使用尽可能低剂量的 CM 可以降低 CIN 的风险。在动物研究和有限的临床试验中，在冠状动脉造影期间，在 CM 进入体循环之前，从冠状窦中清除大部分 CM，可以降低 CIN 的风险。在高危患者中应用某些血管扩张剂（内皮素拮抗剂和腺苷拮抗剂）和抗氧化剂（N-乙酰半胱氨酸和他汀类药物）预防 CIN 的不一致数据存在，新的血管扩张剂和抗氧化剂仍在不断被测试。
经皮导管水化、停用肾毒性药物和使用尽可能低剂量的 CM 是降低 CIN 风险的有效措施。其他预防策略和一些药物具有很大的前景，但需要进一步的证实。
