Neĭmark M I, Merkulov I V, Flat M K
Anesteziol Reanimatol. 2005 Jul-Aug(4):18-22.
The authors analyzed different modes of prevention of acute renal failure (ARF) in the planned surgical treatment of abdominal aortic aneurysms. A hundred patients randomly divided into 4 groups were examined. In patients from a control group, prevention of renal failure included no use of aminoglycosides, prevention of hyperglycemia, and provision of steady-state hemodynamics. In Group 2 patients, the reperfusion syndrome was prevented through a preventive load and early administration of antioxidants, for which they were enterally fed with Berlamine-modular for 5 days before surgery and in the postoperative period. The authors made efforts for Group 3 patients to have high oxygen supply values at all stages of surgical treatment. For this, they optimized infusion therapy and compensated for intraoperative blood loss by preoperatively prepared autoblood and through reinfusion of the blood collected from an operation wound with "Cell saver" apparatus. In Group 4 patients, the prevention of ischemia and reperfusion were simultaneously made and blood oxygen-transporting function was optimized. Renal function was evaluated from the activity of urinary enzymes and from nitrogen metabolic parameters. The studies have indicated that activation of free radical lipid peroxidation in the presence of ischemia/reperfusion and blood oxygen-transporting dysfunction plays an important role in the genesis of renal failure during surgical treatment for infrarenal aortic aneurysms. According to the data on changes occurring in urinary enzymatic activities, the preventive load with antioxidants and their early postoperative use ameliorate renal lesion. The similar effect is achieved by the provision of high tissue oxygen supply and uptake at all the stages of surgical treatment. The best effect shown, in addition to enzymuria diminution, by a clinical reduction in the frequency of renal dysfunction is achieved by applying a comprehensive approach to preventing ARF.
作者分析了腹主动脉瘤计划性外科治疗中预防急性肾衰竭（ARF）的不同模式。对随机分为4组的100例患者进行了检查。对照组患者预防肾衰竭的措施包括不使用氨基糖苷类药物、预防高血糖以及维持稳态血流动力学。第2组患者通过预防性负荷和早期给予抗氧化剂来预防再灌注综合征，为此在手术前5天及术后经肠道给予倍他命模块。作者为第3组患者在手术治疗的各个阶段努力使其具有高氧供应值。为此，他们优化了输液治疗，并通过术前准备的自体血以及使用“细胞回收器”装置回输从手术伤口收集的血液来补偿术中失血。第4组患者同时预防缺血和再灌注，并优化血液氧运输功能。通过尿酶活性和氮代谢参数评估肾功能。研究表明，在缺血/再灌注及血液氧运输功能障碍存在的情况下，自由基脂质过氧化的激活在肾下主动脉瘤手术治疗期间肾衰竭的发生中起重要作用。根据尿酶活性变化的数据，抗氧化剂的预防性负荷及其术后早期使用可改善肾损害。在手术治疗的所有阶段提供高组织氧供应和摄取也能达到类似效果。通过采用综合方法预防ARF，除了减少酶尿外，还能在临床上降低肾功能障碍的发生率，从而显示出最佳效果。
