多支病变伴肾功能不全的介入治疗魏盟

1、多支病变伴多支病变伴肾功能不全的肾功能不全的介入治疗介入治疗病史男性，68岁，活动后胸闷一月一年前因稳定型心绞痛行PCI （LAD和RCA，Cypher)，术后半年不规则服药，2月前停药；高血压病、慢性肾功能不全；血脂控制不佳诊断和处理冠心病，劳累型心绞痛PCI术后高血压病3级（极高危）慢性肾功能不全EF=44%Cr=163mol/L（66kg)复查冠脉造影复查冠脉造影一年前冠脉造影一年前PCIRCA: Cypher 3.5*23mm Cypher 2.75*33mmLAD: Cypher 3.0*23mm 预防造影剂肾病的预防造影剂肾病的8 8字诀字诀分层、水化、限量、等渗分层、水化、限量、

2、等渗多支病变肾功能不全多支病变肾功能不全分层“GFR value:39mL/min/1.73m2; The patient has stage 3 CKD”RiskScoreRiskof CINRisk ofDialysis 57.5%0.04%6 to 1014.0%0.12%11 to 1626.1%1.09% 1657.3%12.6%Mehran et al. JACC 2004;44:1393-1399.HypotensionIABPCHFAge 75 yearsAnemiaDiabetesContrast media volumeRisk Factors555433Integer S

3、core1 for each 100 cc3造影剂肾病(CIN)风险评估Serum creatinine 1.5mg/dl4eGFR 60ml/min/1.73 m22 for 40 604 for 20 406 for 20eGFR 60ml/min/1.73 m2 =186 x (SCr)-1.154 x (Age)-0.203X (0.742 if female) x (1.210 if African American)CalculateOR最大推荐对比剂用量最大推荐对比剂用量 (MRCD)1.MRCD = 5 (ml) X 患者体重患者体重 (kg) / 血清肌酐血清肌酐 (mg/d

4、L) 178mL2.造影剂用量（造影剂用量（cc) Ccr6 215mL3.总量总量75 yearsAnemiaDiabetesContrast media volumeRisk Factors555433Integer Score1 for each 100 cc3造影剂肾病(CIN)风险评估Serum creatinine 1.5mg/dl4eGFR 60ml/min/1.73 m22 for 40 604 for 20 406 for 20eGFR 60ml/min/1.73 m2 =186 x (SCr)-1.154 x (Age)-0.203X (0.742 if female) x (1.210 if African American)CalculateOR冠脉造影Stent: Firebird 2.5*33mm 8-14atm 回旋