摘要
目的探讨肾盂恒压灌注下灌注时间与兔肾脏损伤的关系。方法采用新西兰大白兔64只,随机建立肾盂灌注30min、60min、90min及假手术组动物模型,每组16只。灌注压力维持在100cmH2O,灌注液为生理盐水。分别于术后1d、5d留取灌注侧尿液,行24h尿蛋白测定,留取尿液后于术后1d、5d分批处死各组兔子,取灌注侧肾脏标本,行HE染色及透射电镜检查。结果各灌注组与假手术组相比均出现尿蛋白增高(P<0.05),且尿蛋白随灌注时间的延长而增加(P<0.05);各灌注组术后5d尿蛋白含量与术后1d相比降低(P<0.05);HE染色显示:术后第1天灌注30min组少数肾小球增大,囊腔及肾小管扩张,上皮细胞轻度水肿;随着灌注时间延长,扩张的肾小球增多且在灌注90min组时肾小管内出现大量蛋白管型。术后5d与术后1d各组比较,肾小球及肾小囊基本恢复正常,肾小管蛋白管型明显减少或消失。透射电镜下观察显示:术后第1天灌注30min组肾小球毛细血管管腔、肾小囊囊腔轻度扩张,随着灌注时间的延长,毛细血管腔及肾小囊腔扩张更加明显,灌注90min后可见部分细胞及细胞内线粒体出现空泡化。术后5d各组肾小球毛细血管管腔及肾小囊基本恢复正常或管腔扩张程度明显减轻。结论肾盂恒压灌注下灌注时间对肾脏损伤明显,且灌注时间越长肾脏损伤越严重,但在100cmH2O灌注压力下灌注时间在90min以内造成的肾脏损伤为可逆损伤。
Objective To evaluate the damage on rabbits＇ kidney at different infusion time with constant pressure of renal pelvis.Methods We selected 64 New Zealand white rabbits and established animal models according to renal pelvis infusion time,which was 30 min,60 min,and 90 min respectively.A sham-operation group served as controls.There were 16 rabbits in each group.Normal saline was used as perfusate and the infusion pressure was maintained at 100 cmH2O.Then we colleted the urine from each rabbit from the infusion side the first day and the fifth day after operation and detected the 24 h urinary protein respectively,and then killed all the rabbits to take the kidney specimens of the infusion side,and conducted HE staining and transmission electron microscope examination.Results All rabbits in the experimental groups had changes of urinary protein;the protein of each experimental group increased compared to that of the sham-operation group（P0.05）;urinary protein increased with the prolongation of infusion time（P0.05）;the urinary protein of each infusion group on the fifth day was lower than that on the first day after operation（P0.05）.HE staining showed that： on the first day after operation,the 30 min infusion group had little enlargement of glomerulus and dilatation of renal capsules,and mild edema of epithelial cells;with the prolongation of infusion time,the expansion of glomerulus were increasing and mass urinary casts could be found in renal tubule in the 90min infusion group.On the fifth day after operation,the glomerulus and renal capsule returned to normal mainly,and the protein urinary casts reduced or disappeared basically.The transmission electron microscope showed that： on the first day after operation,in the 30 min infusion group,the glomerular capillary lumen and renal capsule had mild expansion.With the prolongation of the infusion time,the expansion of capillary cavity and renal capsule were more obvious,and 90 minutes after infusion,some cells and mitochondria appeared vacuolation.Five days after operation,the glomerular capillary lumen and renal capsule returned to normal or the luminal expansion reduced significantly in each group.Conclusions The infusion time of renal pelvis under constant pressure can cause significant damage on kidney,and the longer the infusion time is,the more serious the damage is,but the damage will be reversible when the infusion time is less than 90 minutes and the infusion pressure was 100 cmH2O.
出处
《现代泌尿外科杂志》
CAS
2013年第2期141-144,共4页
Journal of Modern Urology
关键词
肾盂灌注
肾脏损伤
尿蛋白
renal pelvis infusion
renal damage
urinary protein
