Oliguria during laparoscopic surgery: Evidence for direct renal parenchymal compression as an etiologic factor
Oliguria during laparoscopic surgery: Evidence for direct renal parenchymal compression as an etiologic factor
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DOI：
10.1089/end.1996.10.1
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发表时间：
1996-02-01
影响因子：
2.7
通讯作者：
Sosa, E
中科院分区：
文献类型：
--
作者：
Razvi, HA;Fields, D;Sosa, E
腹腔镜术中的腹部气腹与一过性少尿有关，排尿后尿量减少。直接肾按压引起Page肾效应被认为是一种机制。为了证实这一理论，在6只麻醉杂种犬的左肾受到15 mm Hg的压力，为此，在不包括肾门结构的肾脏周围放置一个加压袖带，未触及对侧肾脏作为对照，在稳定期后，将加压袖带充气至15 mm Hg，持续2小时，然后进行1小时的恢复期，测量两个肾脏在每个清除期的尿量、肾小球滤过率(GFR)和有效肾血流量(ERBF)，治疗后肾脏平均尿量减少63%(P<；在加压过程中增加了109%(P<；0.05)，袖套剥离后增加了109%。GFR在压缩过程中下降了21%(P<；0.01)，在恢复过程中增加了25%(P<；0.05)。加压期间ERBF下降了26%(P<；0.05)，1h恢复期ERBF未恢复到基线水平，而对照组肾脏在实验和恢复期的尿量或GFR均无明显变化，这些数据支持肾实质直接受压是气腹诱导少尿发生的重要因素，腹腔镜气腹诱导少尿的临床意义值得进一步研究。
Abdominal insufflation during laparoscopy has been associated with transient oliguria, which abates after desufflation. Direct renal compression evoking a Page kidney effect was proposed as a mechanism. In an effort to confirm this theory, the left kidney was subjected to 15 mm Hg compression in six anesthetized mongrel dogs, For this, a pressure cuff was placed around the kidney excluding the renal hilar structures, The contralateral kidney was left untouched to serve as a control, After a steady-state period, the pressure cuff was inflated to 15 mm Hg for 2 hours, Cuff desufflation was followed by a 1-hour recovery period, Urine output, glomerular filtration rate (GFR), and effective renal blood flow (ERBF) were measured for both kidneys during each clearance period, For the treated kidneys, the mean urine output decreased 63% (P < 0.05) during compression and increased 109% (P < 0.05) after cuff desufflation. The GFR decreased 21% (P < 0.01) during compression and increased 25% (P < 0.05) during recovery. The ERBF decreased 26% (P < 0.05) during compression, and during the 1-hour recovery period, ERBF did not recover to baseline values, For the control kidneys, there were no significant changes in urine output or GFR during the experimental and recovery periods, These data support the view that direct renal parenchymal compression is an important factor in the development of insufflation-induced oliguria, The clinical implications of insufflation-induced oliguria during laparoscopy deserve further investigation.