CAJ | 학술논문

目的评价维持目标性腹腔灌注压在腹腔高压状态下对肾功能是否具有保护作用并探索其作用机制.方法将12只健康小香猪随机分为实验组和对照组,每组各6只,两组动物均在全麻后收集单位时间的尿量,连续监测平均动脉压和肾皮质血流;采用CO2气腹法建立腹腔高压模型,连续监测腹腔内压,获得基线平均动脉压、腹腔内压和腹腔灌注压;两组动物腹腔内压自0 mm Hg逐步升高至10 mm Hg、20 mm Hg和30 mm Hg,然后在30 mm Hg水平维持8h后处死动物行肾组织病理学检查.实验组动物在腹腔内压30 mm Hg维持15 min后静脉泵入去甲肾上腺素以维持腹腔灌注压于基线水平为治疗目标,对照组无干预,监测两组动物肾皮质血流、血肌酐、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和尿白细胞介素-18(IL-18)随腹腔内压的变化状况.结果随着腹腔内压的升高,两组动物肾皮质血流均显著下降(P＜0.01);血清Cr与尿IL-18在腹腔内压30 mm Hg维持6h后显著升高(P＜0.05),而TNF-α、IL-6无明显变化(P＞0.05).实验组实施目标性腹腔灌注压后,肾皮质血流显著改善(P＜0.01),尿IL-18显著低于对照组(P＜0.05),两组动物肾组织病理学检查均未发现明显异常.结论在腹腔高压发生的8h内,目标性腹腔灌注压治疗不影响全身炎性介质反应,而是通过改善肾皮质血流发挥一定的肾保护作用.
목적 평개유지목표성복강관주압재복강고압상태하대신공능시부구유보호작용병탐색기작용궤제.방법 장12지건강소향저수궤분위실험조화대조조,매조각6지,량조동물균재전마후수집단위시간적뇨량,련속감측평균동맥압화신피질혈류;채용CO2기복법건립복강고압모형,련속감측복강내압,획득기선평균동맥압、복강내압화복강관주압;량조동물복강내압자0 mm Hg축보승고지10 mm Hg、20 mm Hg화30 mm Hg,연후재30 mm Hg수평유지8h후처사동물행신조직병이학검사.실험조동물재복강내압30 mm Hg유지15 min후정맥빙입거갑신상선소이유지복강관주압우기선수평위치료목표,대조조무간예,감측량조동물신피질혈류、혈기항、종류배사인자-α(TNF-α)、백세포개소-6(IL-6)화뇨백세포개소-18(IL-18)수복강내압적변화상황.결과 수착복강내압적승고,량조동물신피질혈류균현저하강(P＜0.01);혈청Cr여뇨IL-18재복강내압30 mm Hg유지6h후현저승고(P＜0.05),이TNF-α、IL-6무명현변화(P＞0.05).실험조실시목표성복강관주압후,신피질혈류현저개선(P＜0.01),뇨IL-18현저저우대조조(P＜0.05),량조동물신조직병이학검사균미발현명현이상.결론 재복강고압발생적8h내,목표성복강관주압치료불영향전신염성개질반응,이시통과개선신피질혈류발휘일정적신보호작용.
Objective To evaluate the renal protective effect of targeted abdominal perfusion pressure (APP) treatment in intra-abdominal hypertension (IAH) and further investigate its related mechanisms.Methods Twelve healthy pigs were randomly divided into experimental group and control group,each group had 6 pigs.All animals were collected urine volume each hour,continuously monitored mean arterial pressure (MAP) and renal cortical blood flow after anesthesia.IAH models were established by intraperitoneally injecting carbon dioxide in all animals,the baseline MAP,intra-abdominal pressure (IAP)and APP were obtained before IAH models established.In both groups,IAP was raised gradually from 0 mm Hg to 10 mm Hg,20 mm Hg and 30 mm Hg.In control group,IAP was maintained at 30 mm Hg for 8 hours with-out any other interventions.In experimental group,the animals were intravenously given with norepinephrine in order to get a target level of APP equal to its baseline values after 15 minutes of the onset of 30 mm Hg IAP.Changes of renal cortical blood flow,serum creatinine,TNF-α,IL-6 and urine IL-18 with the alteration of IAP in both groups were explored.Animals were then sacrificed for renal histopathology after 8 hours of the onset of 30 mm Hg IAP.Results With the increase of IAP,renal cortical blood flow in both groups was significantly decreased (P ＜ 0.01).Compared to its baseline,serum Cr and urinary IL-18 were significantly up-regulated after the maintenance of IAP at 30 mm Hg for 6 hours in both groups (P ＜ 0.05).However,in experimental group,which utilized a strategy of targeted APP,significant improvement of the renal cortical blood flow was observed (P ＜ 0.01),and urinary IL-18 was significantly lower than the control group (P ＜ 0.05).Renal histopathological examination found no obvious abnormalities either in control group or in experimental group.Conclusions The targeted APP treatment may have some renal protective function within the first 8 hours of IAH by improving renal cortical blood flow rather than affecting systemic inflammatory response.