不同时相远端缺血预处理对腹腔镜肾部分切除病人急性肾损伤的影响
发布时间：2018-09-08 13:49
【摘要】：目的肾脏由于其组织结构和功能的特殊性,是对缺血再灌注损伤(Ischemia-reperfusion injury,IRI)敏感的器官之一。临床上肾IRI比较多见。肾IRI是急性肾衰竭(acute kidney failure, AKF)的常见原因,也是肾脏移植术后影响移植物早期功能恢复和移植物长期存活的主要因素之一。因此,寻求新的治疗策略来降低肾IRI程度是当前临床上密切关注的问题。本实验旨在通过对病人肢体进行间断的缺血预处理,探讨远端缺血预处理(remote ischemia preconditioning, RIPC)早期相保护(第一窗)和晚期相保护(第二窗)对腹腔镜肾部分切除病人急性肾损伤的影响。 方法选择60例肾肿瘤择期行腹腔镜下肾部分切除术的病人随机分为3组：早期远端缺血预处理组(early RIPC,ERIPC组)、晚期远端缺血预处理组(late RIPC,LPdPC组)和对照组(CON组),每组20例。ERIPC组在麻醉诱导前在病人上肢绑骨科气压止血带充气到200mmHg持续5min,放气5min,如此重复3个循环。LRIPC组于手术前24h在病人上肢绑骨科气压止血带充气到200mmHg持续5min,放气5min,如此重复3个循环。CON组不做肢体远端缺血预处理。分别于麻醉诱导前(T0)、术后2h(T1)、6h(T2)抽取颈内静脉血检测血清中性粒细胞明胶酶相关载脂蛋白(NGAL)和血清半胱氨酸蛋白酶抑制剂(胱抑素C, CysC)浓度来评估肾损伤。记录病人术前和术后3个月通过99Tcm-二乙三胺五醋酸肾动态显像(99Tcm-DTPA RDI)测定的单侧肾小球滤过率(GFR)来评估肾功能。 结果三个组术前血清NGAL和CysC基础浓度没有明显的统计学差异。与CON组比较,ERIPC组和LRIPC组病人的NGAL浓度和Cys C浓度在T1、T2均有一定程度的降低(P0.05)。同样与CON组比较,两实验组病人术后3个月患侧肾99Tcm-DTPA GFR百分比改变要小(P0.05)。ERIPC组与LRIPC组比较,后者的NGAL、CysC浓度降低更多,患侧肾99Tcm-DTPA GFR百分比改变更轻微(P0.05)。 结论肢体远端缺血预处理无论早期相还是延迟相对腹腔镜下肾部分切除病人肾缺血再灌注损伤均有一定程度的保护作用,而延迟相保护更明显。
[Abstract]:Objective the kidney is one of the sensitive organs to ischemia reperfusion injury (Ischemia-reperfusion injury,IRI) because of its special structure and function. Renal IRI is more common in clinic. Renal IRI is a common cause of acute renal failure (acute kidney failure, AKF). It is also one of the main factors affecting the early functional recovery and long-term survival of grafts after renal transplantation. Therefore, to seek new treatment strategies to reduce the severity of renal IRI is currently the focus of clinical attention. The purpose of this study was to investigate the effects of early phase protection (first window) and late phase protection (second window) of distal ischemic preconditioning on acute renal injury in patients undergoing laparoscopic partial nephrectomy by intermittent ischemic preconditioning. Methods Sixty patients with renal tumors undergoing laparoscopic partial nephrectomy were randomly divided into three groups: early distal ischemic preconditioning group (early RIPC,ERIPC group), late distal ischemic preconditioning group (late RIPC,LPdPC group) and control group (CON group). In ERIPC group, the upper extremities were tied to orthopedic tourniquet and inflated to 200mmHg for 5 min and exhaled for 5 min before anesthesia induction, so repeated three cycles. LRIPC group inflated orthopedic tourniquet 24 hours before operation until 200mmHg lasted for 5 mins and exhaled for 5 mins. So repeated 3 cycles. Con group did not do distal limb ischemic preconditioning. The serum levels of neutrophil gelatinase-associated apolipoprotein (NGAL) and cysteine protease inhibitor (cystatin C, CysC) were measured before anesthesia induction (T 0) and 2 h (T 1) and 6 h (T 2) postoperatively to evaluate renal injury. Renal function was evaluated by unilateral glomerular filtration rate (GFR) measured by 99Tcm-diethylenetriamine pentaacetic acid renal dynamic imaging (99Tcm-DTPA RDI) before and 3 months after operation. Results there was no significant difference in serum NGAL and CysC levels between the three groups before operation. Compared with CON group, the concentration of NGAL and Cys C in ERIPC group and LRIPC group were decreased to some extent at T _ 1 and T _ 2 (P0.05). Compared with the CON group, the percentage of 99Tcm-DTPA GFR in the affected kidney in the two experimental groups was lower than that in the LRIPC group 3 months after operation (P0.05). Compared with the LRIPC group, the NGAL,CysC concentration in the latter group was lower than that in the LRIPC group, and the percentage of 99Tcm-DTPA GFR in the affected kidney was more slight (P0.05). Conclusion Ischemic preconditioning of distal extremity has a protective effect on renal ischemia-reperfusion injury in patients with partial nephrectomy under laparoscope in both early phase and delayed phase, and delayed phase protection is more obvious than that of Laparoscopic partial nephrectomy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2230703
[Abstract]:Objective the kidney is one of the sensitive organs to ischemia reperfusion injury (Ischemia-reperfusion injury,IRI) because of its special structure and function. Renal IRI is more common in clinic. Renal IRI is a common cause of acute renal failure (acute kidney failure, AKF). It is also one of the main factors affecting the early functional recovery and long-term survival of grafts after renal transplantation. Therefore, to seek new treatment strategies to reduce the severity of renal IRI is currently the focus of clinical attention. The purpose of this study was to investigate the effects of early phase protection (first window) and late phase protection (second window) of distal ischemic preconditioning on acute renal injury in patients undergoing laparoscopic partial nephrectomy by intermittent ischemic preconditioning. Methods Sixty patients with renal tumors undergoing laparoscopic partial nephrectomy were randomly divided into three groups: early distal ischemic preconditioning group (early RIPC,ERIPC group), late distal ischemic preconditioning group (late RIPC,LPdPC group) and control group (CON group). In ERIPC group, the upper extremities were tied to orthopedic tourniquet and inflated to 200mmHg for 5 min and exhaled for 5 min before anesthesia induction, so repeated three cycles. LRIPC group inflated orthopedic tourniquet 24 hours before operation until 200mmHg lasted for 5 mins and exhaled for 5 mins. So repeated 3 cycles. Con group did not do distal limb ischemic preconditioning. The serum levels of neutrophil gelatinase-associated apolipoprotein (NGAL) and cysteine protease inhibitor (cystatin C, CysC) were measured before anesthesia induction (T 0) and 2 h (T 1) and 6 h (T 2) postoperatively to evaluate renal injury. Renal function was evaluated by unilateral glomerular filtration rate (GFR) measured by 99Tcm-diethylenetriamine pentaacetic acid renal dynamic imaging (99Tcm-DTPA RDI) before and 3 months after operation. Results there was no significant difference in serum NGAL and CysC levels between the three groups before operation. Compared with CON group, the concentration of NGAL and Cys C in ERIPC group and LRIPC group were decreased to some extent at T _ 1 and T _ 2 (P0.05). Compared with the CON group, the percentage of 99Tcm-DTPA GFR in the affected kidney in the two experimental groups was lower than that in the LRIPC group 3 months after operation (P0.05). Compared with the LRIPC group, the NGAL,CysC concentration in the latter group was lower than that in the LRIPC group, and the percentage of 99Tcm-DTPA GFR in the affected kidney was more slight (P0.05). Conclusion Ischemic preconditioning of distal extremity has a protective effect on renal ischemia-reperfusion injury in patients with partial nephrectomy under laparoscope in both early phase and delayed phase, and delayed phase protection is more obvious than that of Laparoscopic partial nephrectomy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
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