THE EFFECT OF INCREASED INTRA ABDOMINAL PRESSURE ON RENAL FUNCTION IN MAN
THE EFFECT OF INCREASED INTRA ABDOMINAL PRESSURE ON RENAL FUNCTION IN MAN
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DOI：
10.1172/jci101867
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发表时间：
1947-01-01
影响因子：
15.9
通讯作者：
BRADLEY, GP
中科院分区：
文献类型：
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作者：
BRADLEY, SE;BRADLEY, GP
有效肾血浆流量，肾小球滤过率，和肾小管功能测定在17名正常人受试者的清除和饱和技术期间的应用充气腹带压力。测量下腔静脉和肾静脉中的血压显示，80 mm Hg的压缩压力使腹内压升高至约20 mm Hg。肾有效血浆流量和肾小球滤过率在avg上总是减少24.4%和27.5%。分别对氨基马尿酸钠的肾脏提取保持不变，表明测量血浆流量的清除方法的有效性和不存在动静脉分流。肾小管最大地司特排泄和肾小管最大葡萄糖再吸收同样减少。这种现象不能归因于肾小管转移机制的负荷不足，这是弥漫性或局灶性缺血的结果。腹部压迫导致的所有肾功能降低百分比相等，可解释为（1）部分肾实质的“功能性切断”导致完全的输入小动脉血管收缩，同时残留活性组织中的输出小动脉扩张，以抵消肾静脉压升高的影响，或（2）肾静脉压升高导致肾血流量减少，肾盂内压升高导致尿液从小管流出，终末尿压低，导致阻塞，从而导致大量功能性肾小管组织减少。
Effective renal plasma flow, glomerular filtration rate, and tubular function were measured in 17 normal human subjects by clearance and saturation techniques during the application of a pneumatic abdominal girdle under pressure. Measurement of the blood pressure in the inferior vena cava and renal vein revealed that a compressional pressure of 80 mm. Hg raised intra-abdominal pressure to about 20 mm. Hg. Effective renal plasma flow and glomerular filtration rate were always reduced by 24.4% and 27.5% on the avg. respectively. The renal extraction of Na p-amino hippurate remained unchanged, indicating the validity of the clearance method of measuring plasma flow and the absence of arterio-venous shunting. Maximal tubular diodrast excretion and maximal tubular glucose reab-sorption were equally reduced. This phenomenon cannot be attributed to inadequate loading of tubular transfer mechanisms, as a result of either diffuse or focal ischemia. The equal % reduction of all renal functions by abdominal compression may be explained on the basis of (1) complete afferent arteriolar vasoconstriction with "functional amputation" of a portion of renal parenchyma and simultaneous dilation of efferent arterioles in residual active tissue to counteract the effect of increased renal venous pressure or (2) reduction of renal blood flow by increased renal venous pressure and reduction of the mass functioning tubular tissue by obstruction due to increased intra-pelvic pressure to outflow of urine from tubules with low terminal urinary pressures.