Renal protective effect and its related mechanisms of elevated abdominal perfusion pressure treatment in acute kidney injury model caused by intra-abdominal hypertension
Zheng Yue, Ma Wen-liang, Jiang Yi-jia, Huang Li-feng, Sui Feng, Li Wen Xiong
SICU, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
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25 mm Hg，然后在25 mm Hg水平维持8 h后处死动物行肾组织病理学检查。实验组动物在IAP 25 mm Hg维持15 min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-α、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IAP 25 mm Hg维持8 h后明显升高(P＜0.05)，尿量明显减少，血清TNF-α、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-α、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。〖HTH〗结论〓〖HTSS〗在IAH 25 mm Hg维持8 h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。
郑悦，马文良，蒋怡佳，黄立锋，隋峰，李文雄. 提高腹腔灌注压治疗腹腔高压致急性肾损伤的实验研究[J]. 中国急救医学, 2018, 38(2): 123-128.
Zheng Yue, Ma Wen-liang, Jiang Yi-jia, Huang Li-feng, Sui Feng, Li Wen Xiong. Renal protective effect and its related mechanisms of elevated abdominal perfusion pressure treatment in acute kidney injury model caused by intra-abdominal hypertension. Chinese Journal of Critical Care Medicine, 2018, 38(2): 123-128.
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