在充分水化基础上维生素c对造影剂肾病的预防作用

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1、授予单位代码10089_学号或申请号13370HebeiMedicalUniversity硕士学位论文在职科学学位在充分水化基础上维生素c对造影剂肾病的预防作用学位申请人：左静导师：谷国强教授专业：内科学二级学院：第二医院2015年3月河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师（或指导小组）的指导下，由本人独立完成。本学位论文研究所获的研究成果，其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文相关的论文，第一署名单位为河北医科大学，试验材料、原始数据、申报的

2、专利等知识产权均归河北医科大学所有。否则，承担相应的法律责任。研究生签名：厂一,导师签章、I>广年h月，日河北医科大学研究生学位论文独创性声明•本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外，文中不包含其他人已经发表或撰写的研究成果，指导老师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名导师签章目录中文摘要·············································································1英文摘要···

3、··········································································4研究论文在充分水化基础上维生素C对造影剂肾病的预防作用前言·············································································8材料与方法····································································9结果·······

4、······································································10附表·············································································12讨论·············································································14结论·····························

5、················································18参考文献·······································································18综述造影剂肾病临床研究概况···············································21致谢··········································································

6、·········32个人简历·············································································33中文摘要在充分水化基础上维生素C对造影剂肾病的预防作用摘要目的：在当下心血管疾病由单纯的药物治疗向介入手术治疗技术的转变过程中，造影剂的使用频率不断的增加，由造影剂引发的造影剂肾病的发生率呈不断上升的趋势。造影剂肾病(contrastinducednephropathy,CIN)是指在介入治疗中使用造影剂后2至3天内发生的急性肾功能损害，并

7、排[1]除了其他肾脏损害因素。随着放射技术在临床应用中的逐步进展，各种介入手术医疗器械不断更新的情况下，经皮冠状动脉介入手术技术被普遍使用，同时造影剂的使用也日趋普遍。尽管造影剂由离子型转变为非离子型,由高渗型发展为等渗型,现实中因造影剂所致的急性肾损伤却接连发生,而且其发生率随着手术量的增加不断攀升，已成为目前各级医院院内[2]发生肾衰竭的第三位原因。而临床上目前仍缺乏行之有效的治疗方法，因此，如何预防造影剂肾病，已成为目前较为重要的问题。造影剂肾病的病理机制目前仍不是非常的明确。目前较为普遍的认识是肾缺血为造影剂[3]肾

8、病的最主要的发病机制,第二是肾小管毒性所致。造影剂可导致肾髓[11]质缺血性损伤，造影剂也能对肾小管上皮细胞造成直接的毒性。临床工作中所应用的造影剂主要是以三碘苯甲酸为基础原料的含碘化合物。含碘造影剂为水溶性物质,与血浆蛋白的结合很少。在血液中所含有的造影剂主要是通过肾小球进行滤过及排泄,