摘要
隨著顯影劑使用的增加，顯影劑腎病變已成爲醫源性急性腎衰竭的重要原因，占住院中急性腎衰竭原因的第三位。本文以一進行心臟冠狀動脈攝影後造成顯影劑腎病變之個案爲例，回顧文獻及討論相關治療作爲。病人爲一位66歲女性，有長期糖尿病、高血壓及腎功能不全的病史。患者因胸痛至急診求診，在診斷爲急性心肌梗塞後住院並安排心導管檢查。心導管術後兩天，患者併發急性腎衰竭，在給予支持性治療後，於術後十一天腎功能回復至基礎值出院。顯影劑腎病變會增加病患住院天數、醫療成本以及長期罹病率和死亡率，因此應予以適當之預防。對於必須接受顯影劑檢查及治療之高風險病患，應給予靜脈輸液補充合併高劑量口服的N-acetylcysteine；避免使用一些潛在腎毒性、影響腎功能的藥物；選擇滲透壓較低的顯影劑使用，並於術中盡可能地減少用量。顯影劑使用後應於24-48小時再次評估其腎功能。顯影劑腎病治療多爲支持性療法，在嚴重的患者必要時給則須要透析治療。總之，術前詳細評估並給於適當預防將可降低顯影劑腎病變的發生。
並列摘要
With the increasing use of contrast media, contrast-induced nephropathy (CIN) has become the third leading cause of hospital-acquired acute renal failure. Here we demonstrated a case of CIN developed after coronary angiography, reviewed related articles, and discussed about the proper mamagements. This 66-yearold female who had a past history of diabetes mellitus, hypertension, and chronic kidney disease, visited our emeregency department due to chest pain. She was then hospitalized under the diagnosis of acute myocardial infarction. However, acute renal failure occurred two days after coronary angiography. Under supportive care, she returned her baseline renal function and was discharged 11 days after the procedure. The development of CIN is related with increased hospitalization duration, medical costs, and long-term morbidity and mortality, therefore, it should be prevented as possible. When the use of contrast agent is not avoidable in those high-risk populations, prophylaxis methods include periprocedural intravenous fluid hydration, use of high dose oral N-acetylcysteine, avoid nephrotoxic drugs and those affecting renal hemodynamics, choose low osmolarity contrast media, and minimize the contrast media volume. Re-evaluation of renal function is recommended 24-48 hours after the procedure. The treatment for CIN is mainly supportive and dialysis may be needed in the most severe cases. In conclusion, lower incidence of CIN can be achieved by detailed evaluation and appropriate prevention strategy.
被引用紀錄
延伸閱讀
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