The optimal selective perfusion flow rate of kidney during thoracoabdominal aortic aneurysm surgery : an experimental analysis in dogs.

目的：内脏动脉选择性灌注（SP）是预防胸腹动脉瘤手术中器质性缺血的一种有效辅助方法。然而，合适的灌注流速尚不明确。本研究试图描述肾脏中与不同灌注流速相关的变化。方法：28只狗行开腹手术，双肾暴露。将输注灌注液的导管引入左肾动脉。选择正常血液灌注肾脏2小时后恢复正常循环2小时。对侧肾脏作为对照。测定肾皮质ATP、无机磷（IP）和乳酸（LA）。按灌注速率将灌注肾分为以下4组：第一组（G1）：灌注流量为肾原血流量的10%。第二组（G2）： 25%。第三组（G3）： 50%。第四组（G4）： 100%。结果：再灌注2h后，G1、G2组ATP含量与对照组比较差异有统计学意义，但再灌注2h后，G2组ATP含量恢复正常。G3、G4无明显差异。SP后G1期IP、LA水平明显升高，再灌注后降低。G2组形态变化轻微，G1和G4组更为明显。SP期间，G4平均肾动脉压超过200 mmHg。结论：G3组肾功能基本维持正常，而G2组肾功能出现可逆性改善。

Object : Selective perfusion (SP) of the visceral arteries is a useful adjunctive method for the prevention of organic ischemia during thoracoabdominal aneurysm surgery. However, the appropriate perfusion flow rate is unclear. The present study attempts to characterize the changes seen in the kidney associated with various perfusion flow rates. Method : 28 dogs underwent laparotomy and both kidneys were exposed. A cannula delivering perfusate was introduced in to the left renal artery. The kidney was perfused selectively with normothermic blood for 2 hrs and then returned to normal circulation for 2 hrs. The contralateral kidney served as a control. ATP,inorganic phosphorus (IP) and lactic acid (LA) of the renal cortex were measured. The perfused kidneys were classified into the following 4 groups according to perfusion flow rate.Group 1 (G1) : perfusion flow 10% of native renal blood flow. Group 2 (G2) : 25%. Group 3 (G3) : 50%. Group 4 (G4) : 100%. Results : There was a significant difference in ATP content between G1, G2 and the control group after 2 hrs SP.However, the ATP content was restored in G2 after 2hrs reperfusion. No significant difference was observed in G3 and G4. The level of IP and LA increased significantly in G1 after SP and then decreased after reperfusion. Morphological change was slight in G2, and more pronounced in G1 and G4. During SP,mean renal artery pressure exceed 200 mmHg in G4. Conclusion : The renal function was maintained to almost normal in G3, whereas reversable improvement of renal function was seen in G2.