In A Preventive Effect On The Basis Of Adequate Hydration Of Vitamin C On CIN

Background and Purpose:In the transition from a simple moment of cardiovascular disease medication therapy to surgical intervention, the frequency of use of contrast agents continue to increase, the incidence of contrast induced by contrast induced nephropathy showed a rising trend. Contrast-induced nephropathy(contrast induced nephropathy, CIN) refers to the occurrence of acute renal dysfunction after contrast agent in the interventional treatment of 2-3 days, side by side, in addition to other factors of renal damage [1]. With the gradual progress of radiation technology in clinical applications, a variety of surgical intervention case constantly updated medical devices, percutaneous coronary intervention surgical techniques are commonly used, but the use of contrast agents are becoming increasingly common. Although the contrast agent is non-ionic transition from ionic, by hypertonic isotonic model-based development, in reality, because of the contrast agent-induced acute kidney injury has occurred, and its incidence increases surgical volume continues to rise, has become the third leading cause of nosocomial current levels of occurrence of renal failure [2]. The clinic is still a lack of effective treatment, therefore, how to prevent contrast-induced nephropathy, has become a more important issue. Pathogenesis of contrast-induced nephropathy is currently still not very clear. Currently more common understanding of renal ischemia is the most important for contrast-induced nephropathy pathogenesis, and the second is due to renal tubular toxicity [3]. Contrast agents may lead to renal medullary ischemic injury, contrast agents can cause direct toxicity to renal tubular epithelial cells [11]. Clinical application of contrast agent in the iodine-containing compounds triiodobenzoic acid-based raw materials mainly. Iodine contrast agent is a water soluble substance, and plasma protein binding rarely. The contrast agent in the blood contained primarily through glomerular filtration and excretion, is not secreted nor reabsorbed by the renal tubules during, and tubular water in highly concentrated, the concentration of the contrast agent followed liter high, thereby enabling the tubular epithelial cell damage. Original test showed a contrast agent for renal tubular endothelial cells has a direct toxic effect, the cause of renal medullary hypoxia but also aggravate the side effects on renal tubular endothelial cells, thus creating a vicious cycle. Clinic, more agreeable way to prevent contrast-induced nephropathy is a preventive hydration. For some drugs if there is a genuine role in prevention, there is no support for a large number of templates, but there are some studies to prove the existence of a role when certain drugs reduce the incidence of contrast-induced nephropathy.Vitamin C is ascorbic acid, an effect that is highly water-soluble antioxidants. The absorption rate varies intake while there are some differences, within a certain range of the absorption rate and safe intake is inversely proportional. As a free radical scavenger, can effectively remove the body of oxygen free radicals, the mechanism by scavenging reactive oxygen molecules in the body, control of lipid peroxidation, to protect the role of vascular endothelial cells. The use of vitamin C above characteristics, clinical applications may play interventional treatment of acute renal dysfunction after contrast agent resulting in proactive prevention. While vitamin C on renal tubular epithelial cell membrane may play a protective role, reducing apoptosis of renal tubular epithelial cells, renal tubular cells at the same time help promote regeneration and recovery. In theory, it has a role in the prevention of contrast-induced nephropathy. But the studies are conflicting views on its preventive role. Part of the study results suggest that no clear preventive effect of vitamin C in the prevention of contrast-induced nephropathy, analysis of the reasons may be excessive intake of vitamin C related. This study was designed to investigate the preventive and therapeutic effects of vitamin C for contrast induced nephropathy.Research Methods: 2014.1 to 2014.12 in Huanghua City People’s Hospital, Department of Cardiology, coronary angiography or PCI in 400 patients. 257 cases were male, female 143 cases. Patients were randomly divided into vitamin C group and the control group, 200 cases in which vitamin C group, 200 cases in the control group. 4 hours ago all patients to 1ml / kg / h saline infusion, continued until after 24 hours. vitamin C group 1g of vitamin C. in saline hydration per 500 ml The control group without any treatment.Diagnostic criteria: After application of contrast agent within 48 hours of serum creatinine increased 25% over the previous or liters 0.5mg / dl, and the exclusion of other causes of acute renal injury. MDRD GFR is calculated according to the formula: GFR(ml / min / 1.73m2) = 186 ×(Scr)-1.154 ×(age)-0.203(× 0.742 female); Cockcroft-Gault formula based on serum creatinine clearance : Ccr(ml / min) = [(140- age) × weight ×(0.85 F)] /(72 × Scr).Evaluation: Detection intervention 48 hours after surgery serum creatinine concentration. Compare each group before surgery, serum creatinine level, glomerular filtration rate, changes in serum creatinine clearance; simultaneously compare the index change and the incidence of contrast-induced nephropathy among vitamin C group and control whether the statistics significance.Statistical Methods: SPSS16.0 software for statistical analysis. Measurement data into a set of data using t test, count data into a set of data using chi-square test(Pearson uncorrected method). Was used to compare the incidence of contrast-induced nephropathy chi-square test.Results: After vitamin C group and control group, serum creatinine levels were significantly different(P <0.01). The incidence of contrast-induced nephropathy after vitamin C group were compared with the control group, the results were 14% and 18%, with statistical significance(P <0.01).Conclusion: In this study, vitamin C group before surgery, postoperative serum creatinine, glomerular filtration rate and serum creatinine clearance with the control group of patients, the respective values after comparing the two groups at the same time contrast-induced nephropathy the incidence of other information to prove that on the basis of full hydration of vitamin C can serve to reduce the incidence of contrast-induced nephropathy in effect.