Effect of the technique for assisting renal blood circulation on ischemic kidney in acute cardiorenal syndrome.
Effect of the technique for assisting renal blood circulation on ischemic kidney in acute cardiorenal syndrome.
复制标题
肾血循环辅助技术对急性心肾综合征缺血性肾脏的影响
DOI：
10.1007/s10047-011-0613-5
复制
发表时间：
2012
期刊：
影响因子：
1.3
通讯作者：
Tatsumi E.
中科院分区：
文献类型：
--
作者：
Hanada S;Takewa Y;Mizuno T;Tsukiya T;Taenaka Y;Tatsumi E.
由于肾血循环减少导致的肾缺血性功能障碍是急性心肾综合征（ACRS）的一个强有力的不良预后因素，因此，辅助肾血循环技术可能是一种有用的治疗方法。建立山羊右室快速起搏急性肾功能衰竭模型（n= 8），建立辅助肾动脉压力和血流的回路，对左肾进行肾选择性血液灌注（RSP），并以完整的右肾作为内对照。诱导ACRS后，左肾的肾动脉血流量（RAF）、肌酐清除率（CCr）和肾耗氧量（RVO2）分别降至基线值的49%、48%和63%，同时肾血管阻力（RVR）显著增加，在右肾中观察到类似结果。然后，RSP改善了RVR，并使左RAF、CCr和RVO2分别增加至基线值的91%、86%和93%，而全身血流动力学无显著变化。与对侧肾脏相比，经RSP处理的肾脏显示出显著更高的CCr以及水和钠的尿排泄。额外输注前列腺素E1和RSP进一步降低了RVR，并使左侧RAF增加至基线值的129%，而全身血流动力学参数无显著变化。CCr和RVO2无明显变化，尿水和钠排泄量呈增加趋势。这些发现表明，双肾辅助肾血液循环技术可能为ACRS患者提供一种新的治疗策略。
The technique for assisting renal blood circulation may be a useful therapeutic method in acute cardiorenal syndrome (ACRS), because renal ischemic dysfunction due to the reduced renal blood circulation is a powerful negative prognostic factor in ACRS. We constructed a circuit assisting renal arterial pressure and flow, and performed renal-selective blood perfusion (RSP) to the left kidney in a goat model of ACRS induced by right ventricular rapid pacing (n= 8), with the right kidney left intact as an internal control. Upon induction of ACRS, renal arterial flow (RAF), creatinine clearance (CCr), and renal oxygen consumption (RVO2) of the left kidney decreased to 49, 48, and 63% of the respective baseline values accompanied by a significant increase in renal vascular resistance (RVR), and similar results were observed in the right kidney. Then, RSP improved RVR and increased left RAF, CCr, and RVO2up to 91, 86, and 93% of baseline values, respectively, without a significant change in systemic hemodynamics. The RSP-treated kidney showed significantly higher CCr and urinary excretion of water and sodium compared to the contralateral kidney. Additional infusion of prostaglandin E1with RSP decreased RVR further and enabled the left RAF to increase up to 129% of the baseline value, without a significant change in systemic hemodynamic parameters. The CCr and RVO2did not change significantly, and urinary excretion of water and sodium showed a tendency to increase. These findings suggest that the technique for assisting renal blood circulation for both kidneys may offer a new treatment strategy for patients with ACRS.