Effects Of Low Dose Furosemide On Preventing Contrast Induced Nephropathy At The Basic Of Adequate Hydration In Patients With Percutaneous Coronary Intervention According To Left Ventricular End-diastolic Pressure And Brain Natriuretic Peptideat Levels

Objective: The purpose of this study was to investigate the effect of low dose furosemide on preventing contrast-induced nephropathy in patients undergoing percutaneous coronary intervention on the basis of full hydration with the guidance of left ventricular end-diastolic pressure and brain natriuretic peptide.Method:A total of 1053 coronary heart disease patients undergoing PCI who were hospitalized in our department from October 2017 to May 2019 were collected.Record all the general conditions,improve preoperative routine examinations,all patients had their venous blood taken before PCI to detect BNP.Four hours before surgery,the patient was given 0.9% sodium chloride injection at a rate of 1ml/kg/h for continuous intravenous hydration,followed by PCI,and hydration was continued for 24 hours following the above procedure.LVEDP was measured in all patients immediately after PCI,and BNP was detected in the test group after PCI.The control group received 20 mg furosemide immediately after PCI,and the test group decided whether to apply furosemide according to the level of LVEDP and BNP.The premise of application was that LVEDP≥15mm Hg or(and)postoperative BNP≥100pg/ml or postoperative BNP value exceeded the preoperative value by more than 50%.Renal function and other indicators were measured 48 hours after surgery.The clinical baseline level and the incidence of CIN were compared between the two groups.The correlation between LVEDP and BNP and CIN was detected by the receiver-operating characteristic(ROC)analyses.Risk factors of contrast-induced nephropathy were screened by logistic regression analysis.P<0.05 was considered statistically significant.Result:1.Regarding the incidence of contrast nephropathy,there were 43 cases of contrast nephropathy in the control group(8.14%,43/528),and 15 cases of contrast nephropathy in the test group(2.86%,15/525),which was statistically significant.2.Logistic regression analysis showed that the OR value of LVEDP was 1.038,95%CI(1.006,1.070),P=0.020<0.05,and the OR value of BNP was 1.001,95%CI(1.000,1.002),P=0.021<0.05,indicating that increased LVEDP and/or BNP levels were risk factors for CIN.Gender(female),ejection fraction and other events are associated with the onset of CIN.3.The ROC curve area of CIN was determined by LVEDP to be 0.606(95%CI: 0.532-0.680,P=0.013),and by BNP to be 0.605(95%CI: 0.519-0.692,P=0.014).4.Spearman correlation analysis showed that the level of LVEDP was positively correlated with the incidence of CIN(correlation coefficient =0.083,P=0.009).And the increase of BNP level was also positively correlated with the development of CIN(correlation coefficient =0.093,P=0.003).Conclusion:1.On the basis of adequate hydration,left ventricular end-diastolic pressure and brain natriuretic peptide were used as the guidance for the application of low-dose furoxime in patients undergoing percutaneous coronary intervention therapy.Compared with the direct application of furoxime,the incidence of CIN in the test group was lower by comparing creatinine value,creatinine clearance rate and glomerular filtration rate.2.Both LVEDP and BNP are positively correlated with CIN,which are important factors for identifying high-risk groups of CIN.