LVEDP是一项非常直接的检测指标,每一常规心导管检查中均可检测。本试验中我们采用了临床实践中最常用的方式,即在左心室中置入猪尾导管,按照标准方法测量压力。这种测量值被用来指导根据LVEDP分组的患者水化治疗的级别。这些指标可有效识别出对更高容量水化产生良好疗效的患者。同时,还可识别出对中度水化治疗获益的患者。
International Circulation: Previous trials on contrast nephropathy involved many healthy patients with no impaired renal function. Do you think this addresses that problem as well?
Dr. Brar: It does because it recruits and enrolls patients who are going to benefit. If you get a lot of healthy patients, you will dilute the treatment effect and you may lose the signal of whether or not therapy is effective. We were very careful in terms of identifying and recruiting patients who were going to be at risk of contrast nephropathy.
《国际循环》:既往对比剂肾病试验纳入了许多肾功能正常的健康志愿者,您认为这种试验同样能解决问题吗?
Dr. Somjot Brar:是的,因为这项试验纳入了将可受益的患者。如果你入选大量健康患者,将可能稀释治疗作用,可能丢失疗法是否有效的信号。我们非常谨慎地筛选和纳入那些具有发生对比剂肾病风险的患者。
International Circulation: How would you respond to a patient with contrast nephropathy?
Dr. Brar: The treatment paradigm here is prevention. Once someone develops contrast nephropathy, there are no effective therapies other than supportive care. At that point, one is removing all nephro-toxic medications and you may try to hydrate the patient, but otherwise there is not much that can be done. It is paramount to indentify therapies that can prevent the injury in the first place.
《国际循环》:对已发生对比剂肾病的患者您如何治疗?
Dr. Somjot Brar:我们的治疗方案在于预防。一旦患者发生对比剂肾病,除支持治疗外并无有效疗法。届时将停止所有肾毒性药物,你可以尝试对患者进行水化治疗,但你能做的仅此而已。因此首要的是识别出能够预防肾损伤的治疗方法。