<International Circulation>: Renal dysfunction is a contraindication to coronary angiography intervention.  A lot of guidelines emphasize hydration for renal dysfunction but there isn’t really a clear recommendation about hydration or what specifically needs to be done.  What do you think of hydration therapy?

  《国际循环》：肾功能不全是冠脉造影介入术的禁忌症。许多指南都强调肾功能不全的水化作用，但是没有一个真正建议水化或者其他需要采取的特殊的措施。您怎么看待水化治疗？

    Prof. Wright:   In my patients who are undergoing diagnostic angiography or interventional procedures who have any hint of some degree of renal insufficiency I recommend hydration for 12-24 hours prior to the procedure.  Some of the hydration can be achieved orally if they are healthy and at home， although sometimes we admit them to the hospital.  I sometimes prescribe IV bicarbonate， although data on that is mixed.  I have stopped using N-acetylcysteine， or muco-mist， because the data really has not shown that it is helpful.  Let me clarify a statement you made and put it into perspective.  Having an angiogram or a procedure with a large load of contrast dye is a risk factor for developing acute renal insufficiency， or in some cases permanent renal insufficiency.  The risks are much smaller than people realize， especially with adequate hydration and careful use of the contrast agents.  We now have enough data as physicians to understand the potential risk of renal failure， the potential risk of percutaneous or surgical revascularization， and in almost all patients it is possible to make a risk benefit analysis and give them enough information to help the physician decide if they wish to take a risk because of the potential benefit.  Another way to more easily understand this is that there is always a risk if you fly an airplane that it will crash and you will die.  There is also a benefit that I could have never visited Asia or Beijing if I didn’t want to fly.  The benefit of flying is that it is possible to travel very far quickly and see more in a lifetime， while the risk is that there is a very small risk of a plane crashing.  That doesn’t mean that I don’t fly or drive a car because there is the same risk/benefit ratio.  Most people make a conscious decision of not being treated versus being treated and in almost all cases the benefits of taking the treatment far outweigh the risks.  The risks of not taking the treatment also often far outweigh the benefit of avoiding the treatment.

    Wright教授:我的病人如果即将接受诊断性造影或者介入手术，但是有证据提示不同程度的肾功能不全，我会建议术前予以水化治疗。我有时开IV碳酸氢钠，尽管资料并不明晰。我已经停止应用N-乙酰半胱氨酸或粘膜雾，因为资料显示他们是无效的。让我澄清一下你一份声明并且展望一下未来。血管造影或者血管介入手术中应用大量的造影剂是急性肾功能不全或某些患者出现永久性肾功能不全的一个危险因素。这一风险比人们想象中的要小得多，尤其是在充分水化以及谨慎使用造影剂时。我们现在有足够的数据，作为内科医生，了解肾衰的潜在风险、经皮或外科手术血运重建的潜在风险以及对几乎所有的患者进行风险获益分析，并且给他们提供足够的信息以帮助内科医生决定由于潜在的获益他们是否愿意冒险一试。另一种更容易理解的方式为你乘坐飞机时总是有风险的，有时飞机会坠毁，你就会因此而丧命。这方面还是有获益的，因为如果我不乘坐飞机的话，我可能永远都到不了亚洲或北京。乘坐飞机的好处是有可能很快就可以到达很远的地方，一生中看到更多的东西，而风险是有几率很小的飞机坠毁的风险。这并不意味着我不乘坐飞机或者开车，因为这两者有相同的风险/获益比。大多数人做要么接受治疗要么拒绝治疗的决定，对于几乎所有的病人来说，接受治疗的获益远远超过其风险。不接受治疗的风险也远远超过了不接受治疗的好处。