THE CONTRIBUTION OF VASCULAR OBSTRUCTION TO THE FUNCTIONAL DEFECT THAT FOLLOWS RENAL ISCHEMIA
THE CONTRIBUTION OF VASCULAR OBSTRUCTION TO THE FUNCTIONAL DEFECT THAT FOLLOWS RENAL ISCHEMIA
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DOI：
10.1038/ki.1987.10
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发表时间：
1987-01-01
影响因子：
19.6
通讯作者：
TORHORST, J
中科院分区：
文献类型：
--
作者：
MASON, J;WELSCH, J;TORHORST, J
对肾缺血和各种治疗程序的大鼠进行实验，以确定血管阻塞的起源和功能后果。为此，在外髓质中对其发生率和严重程度进行了定性和定量评估，在外髓质中尤为突出。缺血前用5或70 mg/kg乙酰水杨酸抑制血小板聚集或用100 IE/kg肝素防止纤维蛋白沉积对髓质充血的发生率没有影响，这些物质没有改善肾功能。然而，通过在缺血后急性升高血压或通过在缺血前减少循环红细胞的数量，充血的发生率和程度可以显著降低或完全消除。这些程序有效地提高滤过肾血流量和血管阻力完全正常，并在减少上皮损伤后3和18小时缺血。得出以下结论：第一，不能通过抑制血栓形成来减轻血管阻塞，但通过提高灌注压或降低红细胞压积可以容易地逆转或防止血管阻塞，这可能是由缺血时红细胞聚集引起的。第二，血管阻塞，这似乎提高肾血管阻力和降低血流量和滤过率，不能仅限于髓质，但也必须存在于皮质。最后，逆转或预防血管阻塞可完全恢复肾灌注，部分恢复肾小球和肾小管功能，大大减少肾小管坏死，从而预防肾功能衰竭。
Experiments were performed on rats subjected to renal ischemia and various treatment procedures to determine the origin and functional consequences of vascular obstruction. To this end, its occurrence and severity was assessed qualitatively and quantitatively in the outer medulla, where it is particularly prominent. The incidence of medullary hyperemia was not influenced by inhibiting thrombocyte aggregation with 5 or 70 mg/kg of acetyl salicylic acid or preventing fibrin deposition with 100 IE/kg of heparin before ischemia, and these substances produced no improvement renal function. The incidence and degree of hyperemia, however, could be substantially reduced or completely eliminated by acutely raising blood pressure after ischemia or by decreasing the number of circulating erythrocytes before ischemia. These procedures were effective in raising filtration renal blood flow and vascular resistance to completely normal, and in diminishing epithelial damage both three and 18 hours after ischemia. The following conclusions are drawn: first, vascular obstruction, which is not lessened by inhibiting thrombus formation but is easily reversed or prevented by raising perfusion pressure or decreasing hematocrit, is probably caused by erythrocyte aggregation during ischemia. Second, vascular obstruction, which appears to raise renal vascular resistance and lower blood flow and filtration rate, cannot be limited to the medulla but must also be present in the cortex. Finally, reversing or preventing vascular obstruction can fully restore renal perfusion, partially restore glomerular and tubular function, greatly reduce tubular necrosis and thus prevent renal failure.