Surgical reversal of two-kidney one clip hypertension during inhibition of the renin-angiotensin system.
Surgical reversal of two-kidney one clip hypertension during inhibition of the renin-angiotensin system.
复制标题
抑制肾素-血管紧张素系统期间手术逆转两肾一夹高血压。
作者：
G. Russell;R. Bing;H. Thurston;J. Swales
清醒的两肾一夹Goldblatt高血压大鼠在持续输注葡萄糖、沙拉菌素或卡托普利的过程中去除了收缩夹。其他注射葡萄糖的动物接受了缺血肾脏的切除或假手术。记录手术前15小时和术后24小时的直接动脉压(BP)。实验大鼠处于高血压的“早期”阶段(持续1-3周)或“慢性”阶段(大于4个月)。接受假手术的动物恢复到手术前的血压。去肾或去肾的动物的血压没有恢复到以前的高血压水平。相反，出现了双相反应，血压从手术后的跌落中部分恢复，然后在24小时内缓慢下降至正常；这一影响发生在高血压的两个阶段。在24小时内，在纠正早期和慢性期高血压方面，摘除缺血肾与摘除缩窄夹同样有效。注射沙拉菌素或卡托普利的大鼠血压出现急性下降(在2小时内)并持续下降，但不会降至正常血压水平。这一下降在所有动物中都是显着的(p<0.01)，除了注射沙拉菌素的慢性期大鼠没有看到显着的下降。尽管输注沙拉菌素或卡托普利的动物开始于较低的术前血压，但对去夹闭的双相反应模式与注入葡萄糖的未夹闭的大鼠相同。因此，对肾素-血管紧张素系统的持续抑制并不改变通过去除收缩夹而产生的高血压的纠正，对手术矫正的反应似乎并不完全由肾素-血管紧张素系统的活性变化所调节，尤其是在慢性期。同样，矫正的速度与血管肥大的作用也不一致。
Conscious rats with two-kidney one clip Goldblatt hypertension had the constricting clip removed during continuous infusion of either dextrose, saralasin, or captopril. Other dextrose-infused animals underwent removal of the ischemic kidney or a sham procedure. Direct arterial blood pressure (BP) was recorded throughout the 15-hour preoperative and subsequent 24-hour postoperative period. Rats were studied in the "early" phase (1-3 weeks duration) or "chronic" phase (greater than 4 months) of hypertension. Animals subjected to a sham procedure returned to preoperative BP values. The BP of animals unclipped or nephrectomized did not return to previous hypertensive levels. Instead, a biphasic response was seen where BP partially recovered from an operative fall and then slowly declined to normal at 24 hours; this effect occurred in both stages of hypertension. At 24 hours, removal of the ischemic kidney was as effective as removal of the constricting clip in the correction of both early and chronic phase hypertension. Rats infused with saralasin or captopril demonstrated an acute (within 2 hours) and sustained fall in BP, but not to normotensive levels. This fall was significant in all animals (p less than 0.01) apart from chronic phase rats infused with saralasin where no significant fall was seen. Although animals infused with saralasin or captopril commenced at a lower preoperative BP, the biphasic pattern of response to unclipping was identical to that of dextrose-infused unclipped rats. Thus, sustained inhibition of the renin-angiotensin system did not modify the correction of hypertension produced by removal of the constricting clip, and the response to surgical correction did not appear to be entirely mediated by changes in the activity of the renin-angiotensin system, particularly in the chronic stage. Equally, the rapidity of correction is not consistent with a role of vascular hypertrophy.