使用二氧化碳血管造影的外周干预后急性损伤 - 危险因素超出有的对比介质
Tim Wittig1,2, Sarah Fischer3, Birte Winther1,2
1Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany.
Life (Basel, Switzerland)
|July 29, 2025
概括
急性损伤 (AKI) 发生在接受CO2导向外围手术的患者中的13.2%,高血压和心力衰竭是关键风险. 达丁类药物的使用和更高的GFR是保护因素.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心血管医学 心血管医学
- 干预性放射学 干预性放射学
背景情况:
- 与对比相关的急性损伤 (CA-AKI) 是内血管手术中的重大风险,特别是在患有外周动脉疾病 (PAD) 和慢性病 (CKD) 的患者中.
- 化对比介质 (ICM) 是CA-AKI的常见原因.
- 二氧化碳 (CO2) 是一种潜在的替代性对比剂,特别适用于高风险患者.
研究的目的:
- 评估PAD和CKD患者经历外周血管造影或干预的急性损伤 (AKI) 的发生率和危险因素.
- 评估使用二氧化碳 (CO2) 作为这种高风险人群的主要对比剂的安全性和结果.
主要方法:
- 在2014年9月至2020年12月期间,对340名患有PAD和CKD (3-5期) 的患者进行了回顾性研究,这些患者接受了外围手术.
- 主要使用二氧化碳作为对比剂,可选的救助使用ICM (80%的病例平均21.23±14.09毫升).
- 使用多变量分析分析介入后的AKI发病率,严重程度和独立风险因素的分析.
主要成果:
- 干预后AKI发生在13.2%的患者中,超过70%被归类为第一阶段.
- 7名患者 (2.1%) 在7天内需要重新进行透析.
- 独立的AKI风险因素包括高血压,心力衰竭和冠状动脉疾病;他类药物或RAAS抑制剂的使用和更高的介入前GFR具有保护作用.
结论:
- 在接受CO2导向外周手术的PAD和晚期CKD患者中,AKI仍然是常见的并发症.
- 虽然二氧化碳可以减少ICM暴露,但AKI仍然发生,这突显了这一患者群体的脆弱性.
- 需要进行进一步的研究,以阐明AKI在这种情况下的机制,并优化患者的治疗结果.
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