肾静脉上结扎大鼠下腔静脉后的血流动力学和肾功能改变及其临床意义

目的探讨肾静脉平面以上结扎大鼠下腔静脉后的心、肾功能及肾脏病理改变。方法在肾静脉平面以上结扎大鼠下腔静脉,术后1,6,24,48h检测心率、射血分数、心输出量、每搏输出量、鼠尾动脉压等心脏血流动力学指标。术后6h、12h、24h、2d、3d、4d、5d、7d检测血肌酐、尿素氮、24h尿量及N-乙酰-β-D-氨基葡萄糖苷(NAG)酶并观察肾脏病理改变。结果肾静脉平面以上结扎大鼠下腔静脉后心输出量减少、血压下降,但至术后48h可完全代偿。术后血肌酐、尿素氮、尿NAG酶升高,肾脏瘀血并见大量管型;术后第3天,肾脏恢复正常结构;术后第4天,血肌酐、尿素氮恢复正常;术后第5天,尿NAG酶恢复正常。所有动物均存活。结论肾静脉平面以上结扎大鼠下腔静脉,可因回心血量急骤减少和双肾瘀血而影响心、肾功能。但心功能术后48h即可完全代偿。肾功能术后第5天即可完全代偿。建议当腹膜后肿瘤侵及肾静脉以上段下腔静脉时,可在切除肿瘤及累及下腔静脉段后,直接结扎下腔静脉残端,不必附加切除右肾。术后早期应注意经上肢浅静脉补充液体以增加回心血量。

Cardiac hemodynamics and renal function flowing suprarenal ligation of the inferior vene cava in rats

Objective To investigate the cardiac and renal function flowing suprarenal ligation of the IVC in rats.Methods The heart rate,eiection fraction,cardiac output,stroke volume,arterial pressure at 1st,6th,24th,48th hour were measure and blood urea nitrogen (BUN),serum creatinine (SCr),urine NAG/24th hour,urinary output/24th hour were also measured and the renal pathology were detected at 6th hour,12th hour,24th hour,2nd day,3th day,4th day,5th day,7th day after the suprarenal ligation of the IVC.Results Cardiac output,arterial pressure decreased following the suprarenal ligation of the IVC,but compensated completely at 48th hour after the operation.The levels of BUN,SCr,urine NAG/24th hour rose and there were congestion and many cast in the kidneys following the suprarenal ligation of the IVC.The renal pathology returned to nomal at 3th day after operation,BUN,SCr returned to nomal levels at 4th day,and urine NAG/24th hour returned to nomal level at 5th day after aperation.All rats in this group survived during the study period.Conclusions The cardiac and renal funtion was affected by the cardiac decrease and congestion of two kidneys following the suprarenal ligation of the IVC,but the cardiac and renal funtion returned to nomal level at 48th hour and 5th day after the operation.It is suggested to ligate the suprarenal IVC after resecting the tumor and infiltrated IVC,not to resect nomal right kidney.Solution should be infused by upper limb to increase returned blood volume in early phase after the operation.