Louie E K, Al-Sadir J, Emmanouel D
Cathet Cardiovasc Diagn. 1986;12(4):235-9. doi: 10.1002/ccd.1810120407.
Osmotic diuresis resulting from the administration of angiographic contrast poses the potential threat of marked volume losses obligated by the renal excretion of non-reabsorbable solute. We prospectively assessed urinary excretion of solute and water following cardiac angiography in 14 euvolemic subjects without preexisting renal disease, by a protocol that allowed each patient to serve as his own control. During the initial 6 h after the beginning of angiography, contrast administration resulted in increased total osmolar excretion from a control rate of 0.79 +/- 0.09 to 1.09 +/- 0.09 mOsm/min (P less than .05) with a return to control values thereafter. Surprisingly, sodium, potassium, and chloride excretion rates did not differ significantly from control values. After subtraction of the molar contribution of electrolytes, urea, and creatinine from the total osmolar excretion rate, it was apparent that the "residual osmolar excretion rate" of 0.48 +/- 0.05 mOsm/min was markedly elevated over the control value of 0.11 +/- 0.05 mOsm/min (P less than .01), reflecting the excretion of contrast agent. Despite the marked osmotic diuresis, urine output during this period (3.9 +/- 0.2 cc/min) did not differ significantly from the control value of 4.0 +/- 0.3 cc/min. We conclude that marked volume losses are not a necessary concomitant of contrast-induced osmotic diuresis in the euvolemic cardiac patient without renal disease.
血管造影剂注射引起的渗透性利尿会造成显著容量丢失的潜在威胁，这是由不可重吸收溶质经肾脏排泄所致。我们前瞻性评估了14名无基础肾病的血容量正常受试者在进行心脏血管造影术后的溶质和水的尿排泄情况，采用的方案是让每位患者作为自身对照。在血管造影开始后的最初6小时内，注射造影剂导致总渗透量排泄从对照值0.79±0.09 mOsm/分钟增加至1.09±0.09 mOsm/分钟（P<0.05），此后恢复至对照值。令人惊讶的是，钠、钾和氯的排泄率与对照值无显著差异。从总渗透量排泄率中减去电解质、尿素和肌酐的摩尔贡献后，明显可见“残余渗透量排泄率”为0.48±0.05 mOsm/分钟，显著高于对照值0.11±0.05 mOsm/分钟（P<0.01），这反映了造影剂的排泄情况。尽管存在显著的渗透性利尿，但在此期间的尿量（3.9±0.2毫升/分钟）与对照值4.0±0.3毫升/分钟无显著差异。我们得出结论，在无肾病的血容量正常的心脏患者中，显著的容量丢失并非造影剂诱导的渗透性利尿必然伴随的情况。
