应用无创血流动力学监测仪评估肾移植患者手术前后血流动力学改变

目的:终末期肾功能衰竭患者均存在不同程度血流动力学异常,拟采用无创血流动力学检测仪,检测肾移植术后患者血流动力学改变情况.方法:①实验对象:采集2006-04/2007-09就诊于解放军总医院第二附属医院移植中心的肾移植患者16例,围手术期移植肾功能都完全恢复正常,术后定期随访.②实验方法及评估:应用美国BioZ.Com无创血流动力学监测仪,测定15种血流动力学参数进行血流动力学定量评估,包括心率、收缩压、舒张压、平均动脉压、心输出量/心脏指数、每搏输出量/每搏指数、速度指数、加速指数、预射血期、收缩时间比率、液体水平及外周血管阻力/阻力指数.结果:16例肾移植患者全部进入结果分析.伴随着肾移植术后肾功能的改善,患者心率、血压、预射血期、收缩时间比率、外周血管阻力/阻力指数均较术前下降(P < 0.05),心输出量/心脏指数、每搏输出量/每搏指数、速度指数、加速指数较术前提高(P < 0.05),胸腔液体水平(前负荷)下降不明显(P > 0.05).结论:肾移植术后随着尿毒症状态的纠正,患者血流动力学得到明显改善.     

肾脏移植术中血流动力学的变化研究

目的 探讨肾脏移植手术期间血流动力学的变化规律和处理方法.方法 尿毒症患者365例在联合腰麻-硬膜外阻滞麻醉下行肾脏移植术,分别于麻醉后手术开始前、麻醉后30 min、手术结束前,记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等参教,连续监测术中尿量及输血、输液情况.结果 365例肾脏移植患者全部进入结果分析.伴随着肾移植术后肾功能的改善,患者心率、血压、中心静脉压指教均较术前下降(P＜0.05).结论 肾移植术后随着尿毒症状态的纠正,患者血流动力学得到明显改善,通过监测血流动力学变化可以用来评估移植肾的功能.     

The vasoactive systems in the regulation of renal hemodynamics

In the homeostasis of sodium and water metabolism, the kidney plays a pivotal role. It is the center of multiple humoral systems, such as renin angiotensin aldosterone system, arginine vasopressin, atrial natriuretic peptide, and nitric oxide, which control both systemic and renal circulation in concert. Disturbances in these systems secondary to cardiovascular compromise, especially hemodynamic insufficiency in renal circulation, lead to the accumulation of excess sodium and water, resulting in edema formation. So it is crucial to elucidate the relationship between the kidney and these vasoactive systems for the better understanding of pathophysiology of edema and volume retension.     

Arterial hypertension in senile pyelonephritis: the renal hemodynamics

Eighteen patients aged 60 to 80 years suffering from chronic pyelonephritis (CPN) and nephrogenous arterial hypertension (AH) were examined for intrarenal hemodynamics: effective renal blood flow (ERBF), glomerular filtration rate (GFR), filtration fraction (FF), renal vascular resistance (R). Renal hemodynamics in patients with senile pyelonephritis and AH was found to be characterized by a decrease of ERBF, GFR, FF, an increase of R (p less than 0.01), with the alterations being related to the AH intensity, mass of the functioning renal parenchyma (for GFR) and partly (for R) to the pyelonephritis and AH standing. R which is dependent on the duration and course (number of exacerbations) of CPN is one of the factors that determine the development and gravity of AH in senile pyelonephritis.     

Calcium antagonists and renal hemodynamics: implications for renal protection.

Recently, attention has focussed on the effects of calcium antagonists on renal function. When administered in vitro to the isolated perfused kidney, calcium antagonists exhibit consistent actions permitting characterization of their renal hemodynamic effects. Calcium antagonists do not affect the vascular tone of the vasodilated isolated perfused kidney, but they do dramatically reverse the response of this preparation to vasoconstrictor agents. Studies using the isolated hydronephrotic rat kidney model, which permits direct visualization of afferent and efferent arterioles, have demonstrated that calcium antagonists selectively vasodilate preglomerular vessels. The clinical implications of such observations are still being delineated. Nevertheless, the results of preliminary studies in experimental animal models and in human transplant recipients suggest that calcium antagonists exert salutary effects on renal function in clinical settings characterized by impaired renal hemodynamics. Furthermore, a case can be made that these salutary renal hemodynamic effects of calcium antagonists commend their use in the management of essential hypertension.     

妊娠大鼠肾脏血流动力学变化与肾脏微血管细胞色素P450表达的关系

目的探讨肾脏微血管细胞色素P450表达与妊娠大鼠肾脏血流动力学变化的关系。方法比较妊娠晚期与非妊娠大鼠肾脏血流动力学指标差异，运用Western blot和HPLC比较妊娠各个时期与非妊娠大鼠肾脏微血管细胞色素P450表达与活性。结果与非妊娠大鼠相比，妊娠晚期大鼠平均动脉压和肾微血管阻力明显下降（P〈0．05），妊娠期CYP表达增加，产生EETs活性增加。结论妊娠期肾脏血流动力学变化可能与肾脏微血管细胞色素P450表达有关。     

小儿肾积水血流动力学观察及临床意义

目的:研究小儿肾积水血流动力学指标及其临床意义。方法:应用彩色多普勒超声对20例正常小儿肾脏及30例小儿积水肾进行血流动力学研究。结果:①正常小儿肾脏主肾动脉(MRA)、段动脉(SRA)、叶间动脉(IRA)的血流收缩期峰值速度(PS)、舒张期峰值速度(ED)、平均速度(TAMx)、最低速度(TAMn)依次逐渐减小(P<0.01),MRA、SRA、IRA的阻力指数(RI)无明显改变(P>0.05);积水肾的PS、ED、TAMx、TAMn比正常肾脏的血流速度低(P<0.01),积水肾RI比正常肾RI大(P<0.05)。②肾积水术后1个月RI改善最明显,以后的改善将减缓,而其余各项指标在1~6个月期间恢复最为明显。结论:①肾积水时其血流动力学发生相应的变化,其中RI的变化具有较大临床意义。②梗阻性小儿肾积水,其SRA段RI>0.66。③术后RI值不降或反而升高,提示梗阻未完全解除,需再次手术治疗。     

Renal eicosanoids and renal hemodynamics in early borderline hypertension.

To study the modulatory role of renal eicosanoids on renal hemodynamics and electrolyte excretion, pressor doses of norepinephrine (NE) were infused in 10 control subjects (mean age, 26 y) and 13 patients (mean age, 25 y) with borderline hypertension. The highest NE dose used (150 ng/kg/min) produced comparable increases in mean blood pressure in control subjects (20 +/- 2 mmHg) and in patients (23 +/- 3 mmHg). NE induced a significant increase in renal vascular resistance (p less than 0.01, both groups), with a smaller decrease in glomerular filtration rate resulting in a concomitant increase in filtration fraction (p less than 0.01, both groups). The renal hemodynamic changes tended to be more pronounced in borderline hypertension. NE infusion led to similar decreases in electrolyte clearances in the two groups. Urinary prostaglandin (PG)E2, PGF2 alpha (p less than 0.01), and 6-keto-PGF1 alpha increased with NE infusion. Urinary thromboxane (TX)B2 increased slightly in control subjects and decreased in borderline hypertension (p less than 0.05). The 6-keto-PGF1 alpha/TXB2 ratio, an index of vasodilation, was significantly increased (p less than 0.05) in borderline hypertension. These results demonstrate that in both groups pressor infusion of NE induced significant modifications in renal hemodynamics and in urinary electrolyte and eicosanoid excretion. The vasodilatory component of the renal eicosanoid system appears hyperresponsive in borderline hypertension, which may represent an early antihypertensive defense mechanism.     

肾综合征出血热病患者肾血流动力学的彩色多普勒检测

目的探讨肾综合征出血热（HFRS）病程各期几项超声检测指标的临床意义。方法二维超声显像和彩色多普勒超声对经血清IGM抗体证实的48例HFRS患者和42例健康人的肾脏进行检查,对比分析HFRS各期肾实质厚度、主肾动脉、叶间动脉、段动脉及弓形动脉的血流动力学及主肾动脉血流量的变化。结果HFRS发热期,肾实质增厚,各级肾动脉的血流参数及肾血流量与对照组比较差异无显著性;少尿期、移行期及多尿期,肾实质厚度、各级肾动脉的各项血流参数及主肾动脉血流量与对照组比较有统计学意义,随病程的进展有其自身规律。结论二维超声在HFRS的早期诊断中有重要意义,主肾动脉的阻力指数与肾血流量结合对临床补液有指导作用,HFRS各期肾各级分支动脉的血流参数与主肾动脉的血流参数有类似的意义,考虑日常工作中用主肾动脉的血流参数替代各级分支动脉的血流参数。     

Noninvasive Doppler assessment of renal artery stenosis and hemodynamics

We present a review of ultrasonic Doppler methods (duplex scanning) used in the noninvasive assessment of renal artery stenosis and hemodynamics. The clinically successful applications of ultrasonic Doppler methods to the noninvasive assessment of the peripheral and cerebral vasculatures have prompted investigators to apply these methods to the renal artery. Various Doppler criteria for the diagnosis of renal artery stenosis have given sensitivities and specificities that range from 31% to 91% and 88% to 100%, respectively. Furthermore, estimates of renal vascular flows and resistances can be made in echogenic subjects. The technical success rate of the method is operator dependent, consequently, reliable duplex scanning of the renal arteries may be limited to experienced ultrasound laboratories.