Reversal of renal tissue hypoxia during experimental cardiopulmonary bypass in sheep by increased pump flow and arterial pressure
Reversal of renal tissue hypoxia during experimental cardiopulmonary bypass in sheep by increased pump flow and arterial pressure
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DOI：
10.1111/apha.13596
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发表时间：
2020-12-22
影响因子：
6.3
通讯作者：
May, Clive N.
中科院分区：
文献类型：
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作者：
Lankadeva, Yugeesh R.;Evans, Roger G.;May, Clive N.
目的：体外循环期间肾组织缺氧可能参与急性肾损伤的病理生理过程。我们测试了是否可以减轻肾组织缺氧，在心肺转流术的目标泵流量和平均arterial pressure.Methods的组合增加：心脏搭桥术建立在8个仪器绵羊异氟醚麻醉下，在80 mL中心点kg（-1）min（-1）和平均动脉压65 mmHg的目标连续泵流量。然后，我们测试了使用间羟胺（总剂量0.25-3.75 mg）同时将目标泵流量增加到104 mL中心点kg（-1）min（-1）和平均动脉压增加到80 mmHg的效果。我们还测试了从连续流过渡到部分脉动流的效果（脉压类似于15 mmHg）。结果：与清醒绵羊相比，在较低的目标泵流量和平均动脉压下，心肺转流术伴有肾血流量减少（6.8 +/- 1.2至1.95 +/- 0.76 mL中心点每分钟（-1）千克（-1））和肾氧输送（0.91 +/- 0.18至0.24 +/- 0.11 mL中心点每分钟（-1）千克（-1））。皮质氧分压（PO 2）（33 +/- 13至6 +/- 6 mmHg）和髓质PO 2（31 +/- 12至8 +/- 8 mmHg）显著降低。增加目标泵流量和平均动脉压可增加肾血流量（至2.6 +/- 1.0 mL中心点min（-1）kg（-1））和肾氧输送（至0.32 +/- 0.13 mL中心点O-2 min（-1）kg（-1）），并使皮质PO 2恢复至58 +/- 60 mmHg，髓质PO 2恢复至28 +/- 16 mmHg;与有意识的绵羊相似。部分脉动泵流量对肾脏灌注或氧合没有显著影响。结论：在临床可行的范围内，增加目标泵流量和平均动脉压可以纠正实验性CPB期间的肾脏缺氧。
Aim: Renal tissue hypoxia during cardiopulmonary bypass could contribute to the pathophysiology of acute kidney injury. We tested whether renal tissue hypoxia can be alleviated during cardiopulmonary bypass by the combined increase in target pump flow and mean arterial pressure.Methods: Cardiopulmonary bypass was established in eight instrumented sheep under isoflurane anaesthesia, at a target continuous pump flow of 80 mL center dot kg(-1) min(-1) and mean arterial pressure of 65 mmHg. We then tested the effects of simultaneously increasing target pump flow to 104 mL center dot kg(-1) min(-1) and mean arterial pressure to 80 mmHg with metaraminol (total dose 0.25-3.75 mg). We also tested the effects of transitioning from continuous flow to partially pulsatile flow (pulse pressure similar to 15 mmHg).Results: Compared with conscious sheep, at the lower target pump flow and mean arterial pressure, cardiopulmonary bypass was accompanied by reduced renal blood flow (6.8 +/- 1.2 to 1.95 +/- 0.76 mL center dot min(-1) kg(-1)) and renal oxygen delivery (0.91 +/- 0.18 to 0.24 +/- 0.11 mL center dot O-2 min(-1) kg(-1)). There were profound reductions in cortical oxygen tension (PO2) (33 +/- 13 to 6 +/- 6 mmHg) and medullary PO2 (31 +/- 12 to 8 +/- 8 mmHg). Increasing target pump flow and mean arterial pressure increased renal blood flow (to 2.6 +/- 1.0 mL center dot min(-1) kg(-1)) and renal oxygen delivery (to 0.32 +/- 0.13 mL center dot O-2 min(-1)kg(-1)) and returned cortical PO2 to 58 +/- 60 mmHg and medullary PO2 to 28 +/- 16 mmHg; levels similar to those of conscious sheep. Partially pulsatile pump flow had no significant effects on renal perfusion or oxygenation.Conclusions: Renal hypoxia during experimental CPB can be corrected by increasing target pump flow and mean arterial pressure within a clinically feasible range.