Solomon R, Werner C, Mann D, D'Elia J, Silva P
New England Deaconess Hospital, Joslin Diabetes Center, Boston, MA 02215.
N Engl J Med. 1994 Nov 24;331(21):1416-20. doi: 10.1056/NEJM199411243312104.
Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients with chronic renal insufficiency and diabetes mellitus.
We prospectively studied 78 patients with chronic renal insufficiency (mean [+/- SD] serum creatinine concentration, 2.1 +/- 0.6 mg per deciliter [186 +/- 53 mumol per liter]) who underwent cardiac angiography. The patients were randomly assigned to receive 0.45 percent saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide. The mannitol and furosemide were given just before angiography. Serum creatinine was measured before and for 48 hours after angiography, and urine was collected for 24 hours after angiography. An acute radiocontrast-induced decrease in renal function was defined as an increase in the base-line serum creatinine concentration of at least 0.5 mg per deciliter (44 mumol per liter) within 48 hours after the injection of radiocontrast agents.
Twenty of the 78 patients (26 percent) had an increase in the serum creatinine concentration of at least 0.5 mg per deciliter after angiography. Among the 28 patients in the saline group, 3 (11 percent) had such an increase in serum creatinine, as compared with 7 of 25 in the mannitol group (28 percent) and 10 of 25 in the furosemide group (40 percent) (P = 0.05). The mean increase in serum creatinine 48 hours after angiography was significantly greater in the furosemide group (P = 0.01) than in the saline group.
In patients with chronic renal insufficiency who are undergoing cardiac angiography, hydration with 0.45 percent saline provides better protection against acute decreases in renal function induced by radiocontrast agents than does hydration with 0.45 percent saline plus mannitol or furosemide.
注射放射性造影剂是导致肾功能急性下降的常见原因，最常发生于慢性肾功能不全和糖尿病患者。
我们前瞻性地研究了78例慢性肾功能不全患者（血清肌酐浓度均值[±标准差]为2.1±0.6mg/dl[186±53μmol/L]），这些患者接受了心脏血管造影术。患者被随机分配在血管造影术前12小时和术后12小时仅接受0.45%生理盐水，或生理盐水加甘露醇，或生理盐水加呋塞米。甘露醇和呋塞米在血管造影术前即刻给予。在血管造影术前及术后48小时测量血清肌酐，并在血管造影术后收集24小时尿液。放射性造影剂诱发的急性肾功能下降定义为注射放射性造影剂后48小时内基线血清肌酐浓度至少升高0.5mg/dl（44μmol/L）。
78例患者中有20例（26%）在血管造影术后血清肌酐浓度至少升高0.5mg/dl。生理盐水组的28例患者中，3例（11%）血清肌酐有如此升高，而甘露醇组25例中有7例（28%），呋塞米组25例中有10例（40%）（P = 0.05）。血管造影术后48小时呋塞米组血清肌酐的平均升高幅度显著大于生理盐水组（P = 0.01）。
在接受心脏血管造影术的慢性肾功能不全患者中，与0.45%生理盐水加甘露醇或呋塞米进行水化相比，0.45%生理盐水水化能更好地预防放射性造影剂诱发的肾功能急性下降。
