Larcan A, Boulangé M, Fontenaille C, Laprevote-Heully M C, Pabst J C
Pathol Biol (Paris). 1975 Jan;23(1):5-19.
During 76 extracorporeal circulations (CEC) carried out for open heart operations using an identical protocol, the authors carried out renal function tests from the time of administration of the anesthetic to the post-operative period. Various periods may be distinguished: pre-operative, anesthesia induction (CEC 1, CEC 2) post induction (CEC 1, post CEC 2) finally, the post-operative period (post-operative 1 to 4). As far as renal hemodynamics are concerned, the authors made the following observations: constant reduction in thiosulphate clearance and endogenous creatinine clearance, which reflect glomerular filtration. Reduction in PAH clearance, which reflects renal perfusion. Taking into consideration changes in the hematocrit, one may consider that there is a reduction in renal blood flow at all stages of anesthesia. Taking into consideration concomitant variations in blood pressure, one may calculate that intrarenal resistances are increased. The diuresis/minute increases in very great proportions during induction of anesthesia. Plasma osmolality also increases, urinary osmolality becomes reduced and osmolar clearance rises. The ratio between osmolar clearance and creatinine clearance rises. The clearance of free water rises from negative values. The serum sodium becomes slightly reduced, and sodium diuresis increases. Serum potassium becomes slightly reduced and urinary potassium rises. The interpretation of these phenomena is difficult and should take into consideration the experimental conditions. Comparison with published results shows that there are definite differences depending on whether pure or diluted blood is used. It is however, possible to seek the role of the anesthetic, the thoracotomy or the extracorporeal circulation itself and its load, quite independent of prior changes due to decompensation or not of the congenital heart disease, whether or not it has been treated. The study of these changes in renal function permits one to understand better the precariousness of renal perfusion during extracorporeal circulation, imperfectly corrected by osmotic diuresis and responsible for transient and reversible renal hypofunction, liable to lead however, in cases of complications and prolonged low blood flow, to organic renal failure.
在使用相同方案进行的76例心脏直视手术体外循环（CEC）过程中，作者从麻醉给药时起至术后阶段进行了肾功能测试。可区分出不同阶段：术前、麻醉诱导期（CEC 1、CEC 2）、诱导后（CEC 1、CEC 2后），最后是术后阶段（术后1至4）。就肾血流动力学而言，作者有以下观察结果：反映肾小球滤过的硫代硫酸盐清除率和内生肌酐清除率持续降低。反映肾灌注的对氨基马尿酸清除率降低。考虑到血细胞比容的变化，可以认为在麻醉的各个阶段肾血流量均减少。考虑到血压的伴随变化，可以计算出肾内阻力增加。麻醉诱导期间每分钟尿量大幅增加。血浆渗透压也升高，尿渗透压降低，渗透清除率升高。渗透清除率与肌酐清除率的比值升高。自由水清除率从负值升高。血清钠略有降低，尿钠排泄增加。血清钾略有降低，尿钾升高。对这些现象的解释很困难，应考虑实验条件。与已发表结果的比较表明，使用纯血或稀释血会有明显差异。然而，有可能探究麻醉、开胸手术或体外循环本身及其负荷的作用，完全独立于先天性心脏病失代偿或未失代偿、是否已治疗所导致的先前变化。对这些肾功能变化的研究有助于更好地理解体外循环期间肾灌注的不稳定状态，这种状态不能通过渗透性利尿得到充分纠正，会导致短暂且可逆的肾功能减退，但在出现并发症和长时间低血流的情况下，可能会导致器质性肾衰竭。
