A Clinical Study Of The N-Acetylcysteine In Prevention Of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention

Objective To investigate the effects of N-acetylcysteine(NAC)combined with hydration,simple hydration and no special intervention on contrastinduced nephropathy(CIN)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Is there any significant difference in the preventive effect? Methods The study was enrolled in the hospital from November 2017 to September 2018 in a hospital affiliated to the Inner Mongolia Medical University Hospital for the treatment of CHD with PCI.Meet the inclusion criteria and exclusion criteria of this experiment.Perfect preoperative examination and selective coronary angiography(CAG)examination and PCI treatment.Patients were divided into the routine group(n=46 cases),the hydration group(n=46 cases)and the NAC group(n =46 cases);no intervention was given in the routine group.The hydration group intervention regimen hydrates at a rate of 1 ml/kg/h from 6 h before surgery to 6 h after surgery.The speed and total amount of intravenous infusion were selected according to the selected subjects.The heart function and urine volume were adjusted individually.The NAC group intervention was based on hydration.In the NAC group,1 200 mg was given orally one day before operation,and 600 mg was given orally on the day of operation and 24 hours after operation,and the patients were treated with CAG and PCI with iohexol injection as the contrast agent.the maximum amount of contrast agent Vmax(ml)= body weight(kg)× 5.0 / serum creatinine value(Scr)(usually no more than 300ml).Blood samples were collected three times before and 24 h and 48 h after surgery.Serum creatinine(Scr),Cystatin-C(CYS-C)and retinol were measured in three groups.Retinol binding protein(RBP);estimated according to Cockcroft-Gault formula Endogenous creatinine clearance rate(CrCl)(ml/min)=(140-age)× body weight(kg)/ [72(× 0.85 female)× serum creatinine(mg / dL)];according to MDRD formula Estimated glomerular filtration rate(eGFR)(ml/min·1.73m2)=186×(Scr^-1.154)×(age^-0.203)×(0.742 female)。 Results:The baseline data of the three groups were all homogeneous,and there were no statistical difference between the groups,which was comparable.There was no significant difference in the amount of contrast agents in the three groups.There was no significant difference in CYS-C and RBP between the three groups on the day of angiography and 24 h and 48 h after PCI.The Scr of the conventional group was higher than that of the hydration group and the NAC group,and the CrCl and eGFR were decreased,and the difference was statistically significant the hydration group VS the conventional group,the NAC group VS the conventional group(P >0.05).The incidence of the conventional group was significantly higher than that of the hydration group and the NAC group,and the difference was statistically significant(P< 0.05).No adverse events occurred during the follow-up period.Conclusion:1.Hydration treatment can effectively prevent the occurrence of CIN.2.There is no significant difference between NAC combined hydration treatment and simple hydration treatment.