心脏手术病人心肺转流术对肾脏的灌注滤过和氧合作用的影响Effects.PDFVIP

心脏手术病人心肺转流术对肾脏的灌注、滤过和氧合作用的影响 Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery 译者：余晓旭 背景:急性肾损伤是心脏手术心肺转流后的常见并发症。作者评估了 接受了心脏手术的住院病人在常温时心肺转流术中肾血流量、肾小 球滤过率、肾氧消耗和肾脏氧供应/ 需求关系等以及肾氧合作用(主 要结果) 方面的影响。 方法: 18 例术前血清肌酐正常的患者在签署知情同意书后，进行了 常规心脏外科手术，并采用了常温的心肺转流术 (2.5 l · min−1 · m−2)。通过肺动脉和肾静脉导管在心肺转流术的术前、术中和术后， 对全身和肾脏的血流动力学变量进行测量。动脉和肾静脉血液样本 用于测量肾脏的氧供和氧耗。肾脏的氧合作用由肾脏的氧摄取率估 算。在心肺转流术前、术中、术后，对尿中 N-乙酰基 -β-D-氨基葡 萄糖苷酶进行了测定。 结果:心肺转流术导致肾血管收缩和血流的再分配，与血液稀释相结 合，使肾脏供氧量减少 20%，同时肾小球滤过率和肾的氧耗量保持 不变。因此，肾氧摄取率增加了 39%到 45% ，这表明在心肺转流术 中，肾脏的氧供应/ 需求不协调。采用心肺转流术的患者脱机后，由 于血液稀释和肾脏氧耗的增加，肾脏的氧合作用进一步受损，同时 尿 N-乙酰基- β-D-氨基葡萄糖苷酶 /肌酐比值增加了 7 倍。 结论:心肺转流术可损害肾脏的氧合作用，其机制可能是由于心肺转 流术术中和术后的血管收缩和血液稀释，同时增加了管形物的释放。 原文摘要 Effects of Cardiopulmonary Bypass on Renal Perfusion,Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery Lukas Lannemyr, M.D., Gudrun Bragadottir, M.D., Ph.D., Vitus Krumbholz, M.D., Bengt Redfors, M.D., Ph.D., Johan Sellgren, M.D., Ph.D., Sven-Erik Ricksten, M.D., Ph.D. Background: Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery. Methods: Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2.5 l ・min−1 ・m−2) were included after informed consent. Systemic and renal hemodynamic variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial and renal vein blood samples were taken for measurements of renal oxygen delivery and consumpt