目的 探究在主动脉夹层（Stanford B型）合并肾功能不全患者中行完全血管内超声（intravascular ultrasound，IVUS）介导下主动脉腔内修复术（endovascular aortic repair，EVAR）对减少术后肾功能恶化的意义。方法  入选2013 年2月至2015年6月于广东省人民医院心血管研究所心血管内科拟行EVAR治疗的60例主动脉夹层合并慢性肾功能不全患者，使用随机号码信封法随机分为全IVUS组及对比剂造影组各30例。采集术前术后肾功能指标，采用χ²检验或t检验进行两样本单因素分析。结果  与使用传统造影剂手术相比，IVUS介导下行EVAR治疗术后患者的肌酐（creatinine，CREA）、血尿素氮（blood urea nitrogen，BUN）浓度升高明显更少，差异有统计学意义[24 h IVUS组vs.对比剂组：ΔCREA为（10.37±21.88）μmoI·L^-1 vs. （28.12±27.69）μmoI·L^-1，P=0.008；ΔBUN 为（2.26±3.84）mmol·L^-1 vs.  （3.37±3.56）mmol·L^-1, P=0.250; 72 h IVUS vs. 对比剂组：ΔCREA为（7.69±23.43）μmoI·L^-1 vs. （34.85±34.01）μmoI·L^-1，P=0.001; ΔBUN为（2.99±4.71）mmol·L^-1 vs.（6.07±6.32）mmol·L^-1，P=0.037]。两组术后CREA、BUN浓度及对比剂肾病发生率比较，差异无统计学意义（P>0.05）。结论 IVUS介导下行EVAR治疗安全有效，并可减少术后肾功能恶化风险。

关键词：主动脉夹层； 对比剂肾病； 血管内超声； 主动脉腔内修复术

中图分类号：R543        文献标志码：A　　　文章编号：1007-9688（2016）04-0382-04

Intravascular ultrasound-guided endovascular repair for aortic dissection patients with renal insufficiency

XIE Nian-jin, GU Meng-nan, LUO Song-yuan, LIU Yuan, XUE Ling, YANG Fan, LI Wei, LUO Jian-fang, HUANG Wen-hui

(Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institution, Guangzhou 510100, China )

Abstract: Objectives  To investigate the values of intravascular ultrasound (IVUS ) guided endovascular aortic repair (EVAR) in patients with aortic dissection (AD) (Stanford type B) and renal insufficiency. Methods  Totally 60 Stanford type B AD patients with renal insufficiency who were in Guangdong General Hospital from Feb. 2013 to Mar. 2015, half of them were enrolled as IVUS group, others as contrast group. Blood urea nitrogen (BUN) and creatinine (CREA) were obtained peri-operation. χ² test or T test was used for univariate analysis of independent samples. Results  Compared with using contrast, IVUS-guided EVAR can reduce the increase of CREA and BUN[24 h IVUS group vs. contrast group: ΔCREA(10.37±21.88) μmoI·L^-1 vs. (28.12±27.69) μmoI·L^-1, P=0.008；ΔBUN (2.26±3.84) mmol·L^-1 vs.  (3.37±3.56) mmol·L^-1, P=0.250; 72 h IVUS group vs. contrast group: ΔCREA (7.69±23.43) μmoI·L^-1 vs. (34.85±34.01) μmoI·L^-1, P=0.001; ΔBUN (2.99±4.71) mmol·L^-1 vs.(6.07±6.32) mmol·L^-1, P=0.037]. No significant difference of CREA, BUN and incidence of CIN between the two groups after EVAR. Conclusions  IVUS-guided EVAR is safe and effective, and could reduce the risk of deterioration of renal function in patients with renal insufficiency.

Key words: aortic dissection; contrast-induced nephropathy; intravascular ultrasound; endovascular aortic repair