目标性腹腔灌注压治疗在腹腔高压状态下对肾保护的实验研究  

Renal protective effect and its related mechanisms of targeted abdominal perfusion pressure treatment in intra-abdominal hypertension

作　　者：隋峰[1] 李文雄[1] 郑悦[1] 刘薇[1] 张贵辰[1] 王小文[1] 赵松[1] 

机构地区：[1]首都医科大学附属北京朝阳医院外科重症监护室,北京100020

出　　处：《国际外科学杂志》2013年第2期77-81,F0003,共6页International Journal of Surgery

摘　　要：目的评价维持目标性腹腔灌注压在腹腔高压状态下对肾功能是否具有保护作用并探索其作用机制。方法将12只健康小香猪随机分为实验组和对照组，每组各6只，两组动物均在全麻后收集单位时间的尿量，连续监测平均动脉压和肾皮质血流；采用CO2气腹法建立腹腔高压模型，连续监测腹腔内压，获得基线平均动脉压、腹腔内压和腹腔灌注压；两组动物腹腔内压白0mmHg逐步升高至10mmHg、20mmHg和30mmHg，然后在30mmHg水平维持8h后处死动物行肾组织病理学检查。实验组动物在腹腔内压30mmHg维持15min后静脉泵入去甲肾上腺素以维持腹腔灌注压于基线水平为治疗目标，对照组无干预，监测两组动物肾皮质血流、血肌酐、肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）和尿白细胞介素-18（IL-18）随腹腔内压的变化状况。结果随着腹腔内压的升高，两组动物肾皮质血流均显著下降（P〈0．01）；血清Cr与尿IL-18在腹腔内压30mmHg维持6h后显著升高（P〈0．05），而TNF—α、IL-6无明显变化（P〉0．05）。实验组实施目标性腹腔灌注压后，肾皮质血流显著改善（P〈0．01），尿IL-18显著低于对照组（P〈0．05），两组动物肾组织病理学检查均未发现明显异常。结论在腹腔高压发生的8h内，目标性腹腔灌注压治疗不影响全身炎性介质反应，而是通过改善肾皮质血流发挥一定的肾保护作用。Objective To evaluate the renal protective effect of targeted abdominal perfusion pressure （APP） treatment in intra-abdominal hypertension （IAH） and further investigate its related mechanisms. Methods Twelve healthy pigs were randomly divided into experimental group and control group, each group had 6 pigs. All animals were collected urine volume each hour, continuously monitored mean arterial pres- sure （MAP） and renal cortical blood flow after anesthesia. IAH models were established by intraperitoneally injecting carbon dioxide in all animals, the baseline MAP, intra-abdominal pressure （IAP）and APP were obtained before IAH models established. In both groups, IAP was raised gradually from 0 mm Hg to 10 mm Hg, 20 mm Hg and 30 mm Hg. In control group, lAP was maintained at 30 mm Hg for 8 hours with- out any other interventions. In experimental group, the animals were intravenously given with norepinephrine in order to get a target level of APP equal to its baseline values after 15 minutes of the onset of 30 mm Hg IAP. Changes of renal cortical blood flow, serum creatinine, TNF-α, IL-6 and urine IL-18 with the altera- tion of IAP in both groups were explored. Animals were then sacrificed for renal histopathology after 8 hours of the onset of 30 mm Hg IAP. Results With the increase of IAP, renal cortical blood flow in both groups was significantly decreased （P 〈 0.01 ）. Compared to its baseline, serum Cr and urinary IL-18 were signifi- cantly up- regulated ＇after the maintenance of IAP at 30 mm Hg for 6 hours in both groups （ P 〈 0.05 ）. How- ever, in experimental group, which utilized a strategy of targeted APP, significant improvement of the renal cortical blood flow was observed （P 〈 0.01 ） , and urinary IL-18 was significantly lower than the control group （P 〈 0.05）. Renal histopathological examination found no obvious abnormalities either in control group or in experimental group. Conclusions The targeted APP treatment may have some renal protective function within the

关 键 词：腹腔高压 腹腔灌注压 肾循环 炎症 小香猪 动物实验 

分 类 号：R285.5[医药卫生—中药学]