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首页> 外文期刊>Critical care : >Bench-to-bedside review: preventive measures for contrast-induced nephropathy in critically ill patients.
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Bench-to-bedside review: preventive measures for contrast-induced nephropathy in critically ill patients.

机译：病床到病床检查：危重患者造影剂引起的肾病的预防措施。

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An increasing number of diagnostic imaging procedures requires the use of intravenous radiographic contrast agents, which has led to a parallel increase in the incidence of contrast-induced nephropathy. Risk factors for development of contrast-induced nephropathy include pre-existing renal dysfunction (especially diabetic nephropathy and multiple myeloma-associated nephropathy), dehydration, congestive heart failure and use of concurrent nephrotoxic medication (including aminoglycosides and amphotericin B). Because contrast-induced nephropathy accounts for a significant increase in hospital-acquired renal failure, several strategies to prevent contrast-induced nephropathy are currently advocated, including use of alternative imaging techniques (for which contrast media are not needed), use of (the lowest possible amount of) iso-osmolar or low-osmolar contrast agents (instead of high-osmolar contrast agents), hyperhydration and forced diuresis. Administration of N-acetylcysteine, theophylline, or fenoldopam, sodium bicarbonate infusion, and periprocedural haemofiltration/haemodialysis have been investigated as preventive measures in recent years. This review addresses the literature on these newer strategies. Since only one (nonrandomized) study has been performed in intensive care unit patients, at present it is difficult to draw firm conclusions about preventive measures for contrast-induced nephropathy in the critically ill. Further studies are needed to determine the true role of these preventive measures in this group of patients who are at risk for contrast-induced nephropathy. Based on the available evidence, we advise administration of N-acetylcysteine, preferentially orally, or theophylline intravenously, next to hydration with bicarbonate solutions.
机译：越来越多的诊断成像程序需要使用静脉造影造影剂，这导致造影剂诱发的肾病的发生率同时增加。对比剂诱发的肾病的危险因素包括预先存在的肾功能不全（特别是糖尿病性肾病和多发性骨髓瘤相关性肾病），脱水，充血性心力衰竭以及同时使用肾毒性药物（包括氨基糖苷类和两性霉素B）。由于造影剂诱发的肾病导致医院获得性肾衰竭的显着增加，因此目前提倡几种预防造影剂诱发的肾病的策略，包括使用替代成像技术（不需要造影剂），使用（最低等渗或低渗造影剂（而不是高渗造影剂），水合过多和强迫利尿。近年来，已研究了N-乙酰半胱氨酸，茶碱或非诺多m的给药，碳酸氢钠的输注和术中血液滤过/血液透析的预防措施。本文回顾了有关这些较新策略的文献。由于仅对重症监护病房的患者进行了一项（非随机）研究，因此，目前尚无法就针对危重病患者造影剂肾病的预防措施得出确切的结论。需要进一步的研究来确定这些预防措施在这组有造影剂诱发的肾病风险的患者中的真正作用。根据现有证据，我们建议在口服碳酸氢盐溶液水合后，优先口服N-乙酰半胱氨酸或静脉内给予茶碱。

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