急性心力衰竭绵羊搏动性导管泵辅助肾缺血-再灌注后的形态学改变  

Change in kidney morphology after ischemia/reperfusion in a sheep model of acute heart failure supported by pulsatile catheter pump

作　　者：李智成[1] 陈长志[2] 叶清[2] 成少飞[2] 王维俊[2] 汤敏[2] 赵晓刚[2] Y.John Gu 

机构地区：[1]上海市南汇区中心医院胸心外科,上海市201300 [2]上海交通大学医学院附属仁济医院胸心外科,上海市200127 [3]荷兰Groningen大学医院胸心外科,groningen30001

出　　处：《中国组织工程研究与临床康复》2009年第39期7695-7698,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：仁济医院专项基金资助项目~~

摘　　要：背景:有关心力衰竭辅助循环后出现急性肾功能衰竭的报道较多,但在该背景下对肾脏组织的形态学分析却鲜有文献涉及。目的:建立绵羊急性心力衰竭模型,在此背景下于国内首次观察搏动性导管泵短期辅助后缺血-再灌注肾脏的形态学改变。设计、时间及地点:自身对照动物实验,于2003-07/2004-04在上海第二医科大学附属仁济医院心血管外科研究室完成。材料:搏动性导管泵由欧洲人工脏器协会主席、荷兰Groningen大学生物医学工程教授、搏动性导管泵发明者GerhardRakhorst提供。方法:取10只绵羊进行左心衰竭诱导,建立肾缺血-再灌注模型,建模成功后开始搏动性导管泵辅助,辅助持续3h。主要观察指标:分别于心力衰竭前、心力衰竭时及辅助后每隔45min监测并记录血流动力学参数;辅助3h后取肾脏行光镜和电镜观察。结果:10只绵羊中7只成功支持达到规定的时间。成功的7只绵羊在支持期间血流动力学逐步恢复并趋向稳定,血压接近正常的基线值。光镜和电镜检查发现肾脏缺血-再灌注后轻度的急性改变,主要表现为肾小球细胞数量增多,血管扩张充血,肾曲管上皮水肿变性;肾髓质血管扩张充血,间质水肿。结论:急性心力衰竭绵羊经短期辅助后虽恢复了血流动力学指标,但肾脏病理改变依然存在,提示在辅助循环期间,仅凭血流动力学的稳定来判断肾功能的预后是不可靠的。BACKGROUND： Acute renal failure following heart failure assisted circulation have been extensiveiy reported. However, little data have been available concerning morphological analysis of kidney tissues under that condition. OBJECTIVE： To observe morphological change of ischemia/reperfusion kidney in a sheep pulsatile catheter （PUCA） pump short-term support for heart failure model and explore causes of acute renal failure in assisted circulation patients. DESIGN, TIME AND SETTING： Self-contrast animal experiment was performed at the laboratory of Department of Cardiothoracic Surgery, Renji Hospital of Shanghai Second Medical University between July 2003 and April 2004. MATERIALS： PUCA pump was provided by Gerhard Rakhorst, Professor of Biomedical Engineering, University of Groningen. METHODS： After ischemic heart failure in 10 sheep was induced successfully and subsequently ischemia/reperfusion kidney was developed, PUCA pump was activated to support the hemodynamics for 3 hours. MAIN OUTCOME MEASURES： Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 45 minutes after the support. Kidney biopsy specimens for light and electron microscopy were obtained 3 hours after support. RESULTS： PUCA pump support was successful in 7 of 10 sheep for 3 hours. During support with the PUCA pump, Hemodynamic parameters gradually restored to normal and stable condition, and blood pressure was close to baseline at the end of experiment. On both light and electron microscopy examination, mild acute kidney change was observed after ischemia/reperfusion. Cytosis in renal glomerulus associated with vasodilatation hyperemia, endepidermis in renal tubules hydropic degeneration, vasodilatation hyperemia and interstitial edema in renal medulla were the main findings. CONCLUSION： PUCA pump could successfully maintain the hemodynamics for 3 hours in a sheep acute heart failure model, but pathological change in ischemia/reperfusion kidney was remained. It is impossibl

关 键 词：急性心力衰竭 辅助循环 肾脏 缺血-再灌注 

分 类 号：R318[医药卫生—生物医学工程]