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背景:有关心力衰竭辅助循环后出现急性肾功能衰竭的报道较多,但在该背景下对肾脏组织的形态学分析却鲜有文献涉及。目的:建立绵羊急性心力衰竭模型,在此背景下于国内首次观察搏动性导管泵短期辅助后缺血-再灌注肾脏的形态学改变。设计、时间及地点:自身对照动物实验,于2003-07/2004-04在上海第二医科大学附属仁济医院心血管外科研究室完成。材料:搏动性导管泵由欧洲人工脏器协会主席、荷兰Groningen大学生物医学工程教授、搏动性导管泵发明者GerhardRakhorst提供。方法:取10只绵羊进行左心衰竭诱导,建立肾缺血-再灌注模型,建模成功后开始搏动性导管泵辅助,辅助持续3h。主要观察指标:分别于心力衰竭前、心力衰竭时及辅助后每隔45min监测并记录血流动力学参数;辅助3h后取肾脏行光镜和电镜观察。结果:10只绵羊中7只成功支持达到规定的时间。成功的7只绵羊在支持期间血流动力学逐步恢复并趋向稳定,血压接近正常的基线值。光镜和电镜检查发现肾脏缺血-再灌注后轻度的急性改变,主要表现为肾小球细胞数量增多,血管扩张充血,肾曲管上皮水肿变性;肾髓质血管扩张充血,间质水肿。结论:急性心力衰竭绵羊经短期辅助后虽恢复了血流动力学指标,但肾脏病理改变依然存在,提示在辅助循环期间,仅凭血流动力学的稳定来判断肾功能的预后是不可靠的。
BACKGROUND: There have been many reports of acute renal failure after cardiopulmonary bypass. However, little is known about the morphological analysis of kidney tissues in this context. OBJECTIVE: To establish a model of acute heart failure in sheep, and to observe the morphological changes of kidney after ischemia-reperfusion in short-term assisted pulsatile catheter pump in China. DESIGN, TIME AND SETTING: A controlled animal experiment was performed at the Department of Cardiovascular Surgery, Renji Hospital, Shanghai Second Medical University from July 2003 to April 2004. MATERIALS: Pulsatile catheter pumps were provided by Gerhard Rakhorst, president of the European Association of Human Organs, a professor of biomedical engineering at the University of Groningen in the Netherlands, and inventor of pulsatile catheter pumps. Methods: Ten sheep were used to induce left ventricular failure. Renal ischemia-reperfusion model was established. After successful modeling, pulsatile catheter-assisted adjuvant was given for 3 h. MAIN OUTCOME MEASURES: Hemodynamic parameters were monitored and recorded every 45 minutes before heart failure, heart failure and after adjuvant. After 3 hours, the kidneys were examined with light microscope and electron microscope. Results: Seven out of ten sheep were successfully supported for the prescribed time. Seven of the successful sheep recovered hemodynamically and stabilized during support, with blood pressure approaching normal baseline values. Light microscopy and electron microscopy showed renal ischemia - reperfusion mild mild acute manifestations, mainly as an increase in the number of glomerular cells, vasodilation and congestion, renal tubular epithelial edema degeneration; renal medullary dilatation and congestion, interstitial edema . CONCLUSIONS: Although the hemodynamic parameters were recovered after short-term assistance in acute heart failure sheep, pathological changes in the kidney still exist, suggesting that the prognosis of renal function alone is not reliable based solely on hemodynamic stability .