提高腹腔灌注压治疗腹腔高压致急性肾损伤的实验研究  

Renal protective effect and its related mechanisms of elevated abdominal perfusion pressuretreatment in acute kidney injury model caused by intra - abdominal hypertension

作　　者：郑悦[1] 马文良[1] 蒋怡佳 黄立锋[1] 隋峰[1] 李文雄[1] 

机构地区：[1]首都医科大学附属北京朝阳医院SICU,北京100020

出　　处：《中国急救医学》2018年第2期123-128,I0001,共7页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金专项基金主任基金（81341056）

摘　　要：目的评价提高腹腔灌注压（APP）治疗对腹腔高压（IAH）致急性肾损伤（AKI）是否具有保护和治疗作用并探索可能的机制。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（MAP），并用激光多普勒血流灌注成像仪监测肾脏表面灌注；采用二氧化碳（CO2）气腹法建立IAH模型，连续监测腹腔内压（IAP），测得并记录MAP、IAP和APP；两组动物IAP均从基线逐步升高至10、15、20和25mmHg，然后在25mmHg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IAP25mmHg维持15min后静脉泵入去甲肾上腺素以维持APP于基线水平为治疗目标，对照组无干预，监测两组动物肾脏表面灌注、SCr、TNF—d、IL-6和尿IL-18随IAP的变化状况。结果随着IAP的升高，两组动物肾脏表面灌注均明显下降（P〈0．05）；对照组SCr和尿IL-18在IAP25mmHg维持8h后明显升高（P〈0．05），尿量明显减少，血清TNF—a、IL-6明显升高（P〈0．05）。实验组实施目标性APP后，肾脏表面灌注明显改善（P〈0．05），SCr及尿IL-18较对照组明显下降（P〈0．05），尿量明显增加（P〈0．05），而血TNF-a、IL-6较对照组差异无统计学意义（P〉0．05）。两组肾脏病理学检查均表现为皮质。肾小球肿大，肾小管水肿，差异不明显。结论在IAH25mmHg维持8h能导致AKI，提高APP治疗不影响全身炎症反应，而是通过改善肾脏灌注发挥肾保护作用。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 and control group, each had 6 pigs. All animals were collected urine output per hour, continuously monitored mean arterial pressure （MAP） and renal cortical perfusion using laser Dopple perfusion imaging （LDPI） after anesthesia. IAH models were established by intraperitoneally injecting carbon dioxide in all animals, the baseline MAP, intra - abdominal pressure （lAP） and APP were obtained before IAH models established. In both groups, IAP was raised gradually from baseline to 10 mm Hg, 15 mm Hg, 20 mm Hg and 25 mm Hg. In control group, IAP was maintained at 25 mm Hg for 8 hours without any otherinterventions. 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 25 mm Hg IAP. Changes of renal cortical perfusion, serum creatinine, TNF- a, IL- 6 and urine IL- 18 with the alteration of IAP in both groups were explored. Animals were then sacrificed for renal histopathology afler 8 hours of the onset of 25 mm Hg IAP. Results With the increase of IAP, renal cortical perfusion in both groups was significantly decreased （P 〈 0.05 ）. Compared to its baseline, SCr and urinary IL - 18 were significantly increased after the maintenance of IAP at 25 mm Hg for 8 hours in control group （P 〈 0.05）. And, the level of serum TNF - oL and IL - 6 also increased significantly （ P 〈 0.05 ）. In experimental group, which utilized a strategy of elevated APP, significant improvement of the renal cortical perfusion was observed （P 〈0.05）. SCr and urinary IL - 18 were significantly decreased（P 〈 O. 05 ）, but TNF - c~, IL - 6 did not changed significantly （ P 〉 O. 05 ）. Renal histopathological examination i

关 键 词：腹腔高压(IAH) 腹腔间隔室综合征(ACS) 腹腔灌注压(APP) 急性肾损伤(AKI) 肾 灌注 

分 类 号：R692[医药卫生—泌尿科学]