摘要
目的探讨血容量预扩充对气腹环境下家兔肾小球滤过功能和肾超微结构的影响。方法18只健康家兔随机分为三组,均以肌注氯胺酮和咪唑安定的方法全身麻醉。气腹前60 min,A组以15 ml.kg-1.h-1的速度输注6%羟乙基淀粉溶液,B组相同速度输注复方乳酸钠,C组为对照组。气腹后各组均以5 ml.kg-1.h-1的速度输注复方乳酸钠维持。在预扩容60 min(T1)、气腹后30 min(T2)及气腹后60 min(T3)测定平均动脉压(MAP),并测定相同时段的血清微球蛋白(MG)浓度。实验结束,解除气腹5 min后取右肾皮质组织作电镜分析。结果(1)MAP:A、B组较为稳定,C组气腹后明显上升。(2)血清MG:气腹前各组差异无显著意义。气腹后C组较气腹前明显上升(P<0.05);C组与A、B两组比较差异有显著意义(P<0.05)。(3)肾超微结构:均为可逆性改变,C组损害最重,A、B两组较轻。结论预扩容可明显增加气腹期间肾血流量和改善肾功能,缓解气腹所致的肾小球滤过功能下降及肾超微结构损害。
Objective To investigate the effects of blood volume pre-expansion on the glomerular filtration and renal uhrastructure in rabbits under pneumoperitoneum. Methods Eighteen healthy rabbits were randomly assigned to three groups. The rabbits were anesthetized with intramuscular ketamine and midazolam, then 6% hydroxyethyl starch solution and lactate Ringer＇s solution were administerd at a rate of 15 ml · kg^-1 · h^-1 to group A and B for 60 min before pneumoperitoneum. After pneumoperitoneum, all groups were administered lactate Ringers solution at a rate of 5 ml · kg^-1 · h^-1. Mean blood pressure （MAP） was measured at 60 min（T1 ）after volume pre-expansion and 30min（T2） ,60 min（T3 ） after pneumoperitoneum. The serum conentrations of microglobulin（MG）were measured at same timepoints. At 5 min after desufflation , the cotex tissue of right kidney was sampled for the ultramicroscopy. Results （1） MAP changes of group A and B were raletively constant. After pneumoperitoneum, MAP of group C elevated obviously. （2）MG of serum concentrations： there were no significant changes among three groups before pneumoperitoneurn. After pneumoperitoneum, MG in group C was increased significantly compared with that before and with those in group A and 13 （P〈0 0.05）. （3）Renal ultrastructure had diffirent damages： serious in group C, moderate in A and B. Conclusion Blood volume pre-expansion can enhance the effective renal blood flow（ERBF）,improve renal function, alleviate the reduction of glomerular filtration rate （GFR）and the injury of renal utrastructure induced by pneumoperitoneum.
出处
《临床麻醉学杂志》
CAS
CSCD
2006年第3期214-217,共4页
Journal of Clinical Anesthesiology
关键词
扩容
气腹
肾功能
Volume expansion
Pneumoperitoneum ~ Renal function
