Mitaka Chieko, Hirata Yukio, Habuka Kenichiro, Narumi Yutaka, Yokoyama Kuninori, Makita Koshi, Imai Takasuke
Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Japan.
Crit Care Med. 2003 Aug;31(8):2205-10. doi: 10.1097/01.CCM.0000080487.20304.2E.
The suprarenal abdominal aortic cross-clamping during aortic aneurysm repair causes renal dysfunction after surgery. Atrial natriuretic peptide (ANP), a hormone synthesized by the cardiac atria, induces diuresis-natriuresis and increases glomerular filtration rate. Therefore, we tested the hypothesis that prophylactic ANP infusion could limit the development of acute renal failure after aortic cross-clamping.
Prospective, comparative, experimental study.
Laboratory at a university hospital.
Twelve male beagle dogs (10-13 kg) with mechanical ventilation under pentobarbital anesthesia.
A catheter was inserted into the femoral vein, and lactated Ringer solution (10 mL/kg/hr) was administered throughout the study period. Two groups of animals were studied: the control group (n = 6), which received saline vehicle before and after suprarenal abdominal aortic cross-clamping for 1.5 hrs; and the ANP group (n = 6), which received ANP (1 microg/kg/min) for 5 hrs, starting from 10 mins before suprarenal abdominal aortic cross-clamping until the end of procedure.
Changes in systemic and renal hemodynamics, blood gases, and renal function were measured at baseline and 1, 2, 3, 4, and 5 hrs after aortic cross-clamping. After aortic cross-clamping, urine volume, renal blood flow, and creatinine clearance significantly (p <.01) decreased, and serum creatinine concentrations significantly (p <.01) increased, but these effects were limited by continuous ANP infusion.
The present study shows that ANP infusion preserved renal function after suprarenal abdominal aortic cross-clamping in dogs. These results justify a trial of ANP infusion in humans during aortic aneurysm repair.
在主动脉瘤修复手术中，肾上腹主动脉交叉钳夹会导致术后肾功能障碍。心房利钠肽（ANP）是一种由心房合成的激素，可诱导利尿排钠并增加肾小球滤过率。因此，我们检验了预防性输注ANP可限制主动脉交叉钳夹后急性肾衰竭发生的假说。
前瞻性、对比性实验研究。
大学医院实验室。
12只体重10 - 13千克、在戊巴比妥麻醉下进行机械通气的雄性比格犬。
将一根导管插入股静脉，在整个研究期间输注乳酸林格液（10毫升/千克/小时）。研究两组动物：对照组（n = 6），在肾上腹主动脉交叉钳夹前后1.5小时给予生理盐水；ANP组（n = 6），从肾上腹主动脉交叉钳夹前10分钟开始至手术结束，持续5小时给予ANP（1微克/千克/分钟）。
在主动脉交叉钳夹前及钳夹后1、2、3、4和5小时测量全身和肾脏血流动力学、血气及肾功能变化。主动脉交叉钳夹后，尿量、肾血流量和肌酐清除率显著（p <.01）降低，血清肌酐浓度显著（p <.01）升高，但持续输注ANP可限制这些影响。
本研究表明，输注ANP可在犬肾上腹主动脉交叉钳夹后保护肾功能。这些结果证明在人类主动脉瘤修复手术中进行ANP输注试验是合理的。
