口服川芎制剂预防对比剂肾病的疗效和安全性

李长永，张志刚，李娜，白元，秦永文

·心脏介入Cardiac intervention·

口服川芎制剂预防对比剂肾病的疗效和安全性

李长永，张志刚，李娜，白元，秦永文

目的探讨上海长海医院自制川芎口服制剂头痛灵口服液在冠脉介入治疗中预防对比剂肾病（CIN）的疗效及安全性。方法将2014年4月—6月住院行择期冠脉介入的患者随机分为川芎组（113例）和对照组（109例），两组均常规水化治疗，川芎组在水化基础上加用川芎口服制剂头痛灵口服液，比较两组术后CIN的发生及川芎相关药物不良反应的情况。结果冠脉介入术后发生CIN者川芎组有5例（4.42%），对照组有13例（11.9%），两组间差异有统计学意义（χ2=4.191，P＜0.05）。川芎组患者均未出现川芎相关的药物不良反应。发生CIN的18例患者在水化、碱化尿液治疗后均获恢复。结论在水化治疗基础上口服川芎制剂对冠脉介入术后CIN的发生有明显预防作用，且无明显不良反应。

冠脉介入；对比剂肾病；川芎；口服制剂

【Abstract】ObjectiveTo evaluate the safety and efficacy of oral Changhai Hospital self-made preparation of rhizoma chuanxiong in preventing contrast-induced nephropathy（CIN）in patients undergoing selective percutaneous coronary intervention（PCI）.MethodsDuring the period from April 2014 to June 31，2014，a total of 222 patients with cardiac disorders were admitted to Changhai Hospital to receive selective coronary intervention.The patients were randomly divided into the study group（n=113）and the control group（n=109）.Routine hydration therapy with 0.9%sodium chloride solution was performed in the patients of both groups，and additional oral preparation of rhizoma chuanxiong and oral liquid of headache pill were given to the patients of the study group.The incidences of CIN were compared between the two groups，and the chuanxiong-related side effects were analyzed.ResultsThe incidence of CIN occurring after PCI in the study group and the control group was 4.42%（n=5）and 11.9%（n=13）respectively，and the difference between the two groups was statistically significant（χ2=4.191，P＜0.05）.No chuanxiong-related side effects occurred.After hydration therapy and urine alkalization treatment all the 18 patients with CIN returned to normal status.ConclusionOn the basis of hydration therapy，oral preparation of rhizoma chuanxiong can effectively prevent postoperative CIN from happening in patients undergoing selective percutaneous coronary intervention.Besides，oral preparation of rhizoma chuanxiong has no obvious side effects.（J Intervent Radiol，2015，24：102-105）

【Key words】percutaneous coronary intervention；contrast-induced nephropathy；rhizoma chuanxiong；oral preparation

对比剂肾病（contrast-induced nephropathy，CIN）是指患者应用对比剂后导致的医源性急性肾功能损害，一般发生于使用对比剂后48～72 h以内，其定义为血清肌酐（Scr）较基线升高25%或绝对值升高44 μmol/L，并排除其他因素［1］。冠脉介入（PCI）是导致CIN的常见原因。CIN的发生明显增加术后心血管事件发生率及病死率［2］。采取有效的预防措施可减少PCI术后CIN的发生，目前预防手段主要是水化治疗［3］。川芎通过多种机制对肾脏有保护作用，有报道发现川芎静脉制剂预防CIN有一定疗效，但静脉制剂有多种不良反应［4］。为此，我们研究了长海医院自制川芎口服制剂头痛灵口服液在PCI患者中预防CIN发生的疗效及安全性。……