Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy
Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy
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DOI：
10.1016/s0022-5347(05)64520-x
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发表时间：
2002-10-01
影响因子：
6.6
通讯作者：
Crum, LA
中科院分区：
文献类型：
--
作者：
Evan, AP;Willis, LR;Crum, LA
目的：在研究中，为了更好地了解空化在冲击波碎石肾损伤中的作用，我们评估了动物暴露于抑制空化的改良冲击波（压力释放反射性冲击脉冲）时肾损伤的结构和功能标志物。实验也在分离的红细胞中进行，这是一种体外测试系统，是空化介导的冲击波损伤的敏感指标。材料和方法：我们使用未经修改的HM3碎石机（Dornier Medical Systems, Marietta, Georgia），配备标准黄铜椭球反射器（刚性反射器）或压力释放反射器插入，对6周大的麻醉猪进行冲击波碎石治疗。压力释放反射器调换了碎石机冲击脉冲的压缩和拉伸阶段，而不改变冲击波的正压或负压分量。因此，有了压力释放反射器，入射激波的振幅不会改变，但声场中的空化现象得到了抑制。右肾下极24千伏电击2000次。分别于冲击波碎石术前1小时、后1小时、4小时测定2个肾脏肾小球滤过率、肾血浆流量和对氨基尿素小管提取量，并分别取肾进行形态学分析。体外研究评估了激波诱导红细胞对刚性或压力释放反射性冲击脉冲的反应。结果：假冲击波碎石对肾形态、肾血流动力学及对甲氨嘧啶提取无明显影响。用标准刚性反射器施加的冲击波引起了特征性的形态学病变和功能改变，包括双侧肾血浆流量减少，单侧肾小球滤过率和对氨基尿酸提取减少。当使用压力释放反射器时，形态学病变仅限于肾乳头尖端附近的直血管出血，唯一的肾功能变化是在冲击波治疗肾脏的1小时和4小时期间肾小球滤过率下降。压力释放反射镜对体外红细胞溶解的影响明显低于刚性反射镜。结论：这些数据表明，当空化被抑制时，冲击波碎石对肾脏的损害减少。这一发现支持了空化在冲击波碎石术创伤中起重要作用的观点。
Purpose: In studies to understand better the role of cavitation in kidney trauma associated with shock wave lithotripsy we assessed structural and functional markers of kidney injury when animals were exposed to modified shock waves (pressure release reflector shock pulses) that suppress cavitation. Experiments were also performed in isolated red blood cells, an in vitro test system that is a sensitive indicator of cavitation mediated shock wave damage.Materials and Methods: We treated 6-week-old anesthetized pigs with shock wave lithotripsy using an unmodified HM3 lithotriptor (Dornier Medical Systems, Marietta, Georgia) fitted with its standard brass ellipsoidal reflector (rigid reflector) or with a pressure release reflector insert. The pressure release reflector transposes the compressive and tensile phases of the lithotriptor shock pulse without otherwise altering the positive pressure or negative pressure components of the shock wave. Thus, with the pressure release reflector the amplitude of the incident shock wave is not changed but cavitation in the acoustic field is stifled. The lower pole of the right kidney was treated with 2,000 shocks at 24 kV. Glomerular filtration rate, renal plasma flow and tubular extraction of para-aminohippurate were measured in the 2 kidneys 1 hour before and 1 and 4 hours after shock wave lithotripsy, followed by the removal of each kidney for morphological analysis. In vitro studies assessed shock wave induced lysis to red blood cells in response to rigid or pressure release reflector shock pulses.Results: Sham shock wave lithotripsy had no significant effect on kidney morphology, renal hemodynamics or para-aminohippurate extraction. Shock waves administered with the standard rigid reflector induced a characteristic morphological lesion and functional changes that included bilateral reduction in renal plasma flow, and unilateral reduction in the glomerular filtration rate and para-aminohippurate extraction. When the pressure release reflector was used, the morphological lesion was limited to hemorrhage of vasa recta vessels near the tips of renal papillae and the only change in kidney function was a decrease in the glomerular filtration rate at the 1 and 4-hour periods in shock wave treated kidneys. Red blood cell lysis in vitro was significantly lower with the pressure release reflector than with the rigid reflector.Conclusions: These data demonstrate that shock wave lithotripsy damage to the kidney is reduced when cavitation is suppressed. This finding supports the idea that cavitation has a prominent role in shock wave lithotripsy trauma.