接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者术后口服补液与对比剂诱导的急性肾损伤风险之间的关联。
The association between post-procedural oral hydration and risk of contrast-induced acute kidney injury among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
作者信息
Song Feier, Sun Guoli, Liu Jin, Chen Ji-Yan, He Yibo, Chen Shiqun, Chen Guanzhong, Tan Ning, Liu Yong
机构信息
Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
School of Medicine, South China University of Technology, Guangzhou 510100, China.
出版信息
Ann Transl Med. 2019 Jul;7(14):321. doi: 10.21037/atm.2019.06.05.
BACKGROUND
Oral hydration with water may be inexpensive and effective in the prevention of contrast-induced acute kidney injury (CI-AKI), but its efficacy among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unknown.
METHODS
This was a prospective, single-center, observational study. We consecutively enrolled 308 STEMI patients undergoing primary PCI. All patients drank unrestricted amounts of fluids freely, whose volume was recorded until 24 hours following primary PCI. Oral hydration volume/weight ratios (OHV/W) were calculated. Adequate oral hydration was defined as a ratio over 12 mL/kg within 24 hours after primary PCI. The primary outcome measure was CI-AKI, defined as a 25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 hours post-procedure. The association between adequate post-procedural oral hydration and CI-AKI was assessed using multivariable logistic analysis.
RESULTS
Post-procedural prophylactic oral hydration was implemented in 90.91% (280/308) of STEMI patients undergoing primary PCI. There were no differences in the sex, age, weight, index blood pressure, LVEF, anemia, diabetes mellitus, contrast volume used during the coronary procedures between groups (P>0.05). The incidence of CI-AKI was much higher in the inadequate oral hydration group (<12 mL/kg) than the adequate group (≥12 mL/kg) (53.57% . 21.79%, P=0.0002). Multivariate logistic regression showed adequate oral hydration (≥12 mL/kg) was the independent protective factor associated with CI-AKI (OR =0.349, 95% CI: 0.147-0.828, P=0.0170), after adjusting confounders, including age, female gender, baseline serum creatinine, diabetes mellitus, use of diuretics, congestive heart failure and intravenous hydration volume.
CONCLUSIONS
Our study determined the association of post-procedural adequate oral hydration on CI-AKI following primary PCI, which was a potential strategy for CI-AKI prevention among patients with STEMI at very high risk.
背景
口服补水预防对比剂诱导的急性肾损伤（CI-AKI）可能既经济又有效，但其在接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中的疗效尚不清楚。
方法
这是一项前瞻性、单中心观察性研究。我们连续纳入了308例接受直接PCI的STEMI患者。所有患者自由饮用不限量的液体，记录其摄入量直至直接PCI术后24小时。计算口服补水量与体重之比（OHV/W）。充足的口服补水定义为直接PCI术后24小时内该比值超过12 mL/kg。主要结局指标为CI-AKI，定义为术后最初48 - 72小时内血清肌酐较基线水平升高25%或0.5 mg/dL。采用多变量逻辑回归分析评估术后充足的口服补水与CI-AKI之间的关联。
结果
90.91%（280/308）接受直接PCI的STEMI患者进行了术后预防性口服补水。两组在性别、年龄、体重、基础血压、左心室射血分数、贫血、糖尿病、冠状动脉手术中使用的对比剂用量方面无差异（P > 0.05）。口服补水不足组（<12 mL/kg）的CI-AKI发生率远高于充足组（≥12 mL/kg）（53.57%对21.79%，P = 0.0002）。多变量逻辑回归显示，在调整包括年龄、女性性别、基线血清肌酐水平、糖尿病、利尿剂使用、充血性心力衰竭和静脉补水量等混杂因素后，充足的口服补水（≥12 mL/kg）是与CI-AKI相关的独立保护因素（OR = 0.349，95%CI：0.147 - 0.828，P = 0.0170）。
结论
我们的研究确定了术后充足的口服补水与直接PCI术后CI-AKI之间的关联，这是在极高风险的STEMI患者中预防CI-AKI的一种潜在策略。
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