王娜　董慧　佟彦庆　王燕飞

【摘要】 目的 总结高龄冠心病合并慢性肾功能不全行经皮冠状动脉介入治疗（PCI）患者预防造影剂肾病（CIN）护理措施与体会。方法 86例CIN患者术前评价相关危险因素， 做好术前、术后的水化治疗及术中造影剂的应用， 严密观察生命体征， 并精确记录24 h出入量， 重视加强术前、术中及术后的护理。结果 86例患者术后并发CIN 12 例， 占14.0%；12 例患者均应用了水化疗法， 8 例水疗7～9 d血清肌酐恢复正常范围， 占66.7%， 4 例经血液透析3～4次血清肌酐恢复正常范围， 占33.3%。结论 术前、术中、术后应做好护理工作及增强水化治疗对高龄PCI术后CIN发生及改善预后非常重要。

【关键词】 造影剂肾病；慢性肾功能不全；冠心病；经皮冠状动脉介入治疗；高龄；水化治疗；护理

DOI：10.14163/j.cnki.11-5547/r.2017.02.078

Nursing in prevention of contrast media induced nephropathy after percutaneous coronary artery intervention in senile coronary heart disease complicated with chronic renal insufficiency patients WANG Na， DONG Hui， TONG Yan-qing， et al. Department of Cardiology， First Affiliated Hospital of Baotou Medical College， Baotou 014010， China

【Abstract】 Objective To summarize nursing measure and experience in prevention of contrast media induced nephropathy （CIN） after percutaneous coronary artery intervention （PCI） in senile coronary heart disease complicated with chronic renal insufficiency patients. Methods Preoperative evaluation was made on related risk factors in 86 CIN patients. Rehydration therapy before and after operation and contrast media during operation were all applied properly. Vital signs were closely monitored. Detailed records were made on 24 h intake and output volume. Preoperative， intraoperative and postoperative nursing were given high attention. Results Among the 86 patients， there were 12 cases with postoperative complicated CIN， accounting for 14.0%. All the 12 cases received rehydration therapy. There were 8 cases with normal serum creatinine after 7～9 d of treatment， accounting for 66.7%， and 4 cases with normal serum creatinine after 3～4 d of treatment， accounting for 33.3%. Conclusion Proper implement of preoperative， intraoperative， postoperative nursing and enhancement of rehydration therapy are essential for occurrence and prognosis of CIN after PCI in senile patients.

【Key words】 Contrast media induced nephropathy； Chronic renal insufficiency； Coronary heart disease； Percutaneous coronary artery intervention； Senile； Rehydration therapy； Nursing

造影劑肾病（contrast media induced nephropathy， CIN）是指应用造影剂后2～3 d内发生的急性肾功能损伤， 同时排除其他原因导致的肾损伤[1]。随着医学的发展， PCI诊疗术己逐渐成为冠状动脉疾病诊断与治疗的重要方法， 普遍的应用于临床， 含碘造影剂应用范围、用量逐渐增多， CIN发病率逐渐增高， CIN是医院内获得性急性肾损伤的第三大原因[2]。老年人患者的肾功能相对较差， 是PCI的高发人群， 因此预防造影剂导致的急性肾功能损害非常重要。本文共收治86例高龄（81～85岁）冠心病患者， 经皮冠状动脉介入治疗（percutaneous coronary artery intervention， PCI）后并发CIN 12 例。本文对86 例高龄冠心病合并慢性肾功能不全患者行PCI 治疗后预防CIN所应用的护理干预方式报告如下。

1 资料与方法

1. 1 一般资料 选取2014年11月～2016年3月在本科住院的高龄合并慢肾功能不全患者86例（年龄81～85岁）， 其中合并2型糖尿病26例， 高血压病18例， 慢性心功能不全8 例。……