Handa Rajash K, Bailey Michael R, Paun Marla, Gao Sujuan, Connors Bret A, Willis Lynn R, Evan Andrew P
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
BJU Int. 2009 May;103(9):1270-4. doi: 10.1111/j.1464-410X.2008.08277.x. Epub 2008 Dec 22.
To test the hypothesis that the pretreatment of the kidney with low-energy shock waves (SWs) will induce renal vasoconstriction sooner than a standard clinical dose of high-energy SWs, thus providing a potential mechanism by which the pretreatment SW lithotripsy (SWL) protocol reduces tissue injury.
Female farm pigs (6-weeks-old) were anaesthetized with isoflurane and the lower pole of the right kidney treated with SWs using a conventional electrohydraulic lithotripter (HM3, Dornier GmbH, Germany). Pulsed Doppler ultrasonography was used to measure renal resistive index (RI) in blood vessels as a measure of resistance/impedance to blood flow. RI was recorded from one intralobar artery located in the targeted pole of the kidney, and measurements taken from pigs given sham SW treatment (Group 1; no SWs, four pigs), a standard clinical dose of high-energy SWs (Group 2; 2000 SWs, 24 kV, 120 SWs/min, seven pigs), low-energy SW pretreatment followed by high-energy SWL (Group 3; 500 SWs, 12 kV, 120 SWs/min + 2000 SWs, 24 kV, 120 SWs/min, eight pigs) and low-energy SW pretreatment alone (Group 4; 500 SWs, 12 kV, 120 SWs/min, six pigs).
Baseline RI (approximately 0.61) was similar for all groups. Pigs receiving sham SW treatment (Group 1) had no significant change in RI. A standard clinical dose of high-energy SWs (Group 2) did not significantly alter RI during treatment, but did increase RI at 45 min after SWL. Low-energy SWs did not alter RI in Group 3 pigs, but subsequent treatment with a standard clinical dose of high-energy SWs resulted in a significantly earlier (at 1000 SWs) and greater (two-fold) rise in RI than that in Group 2 pigs. This rise in RI during the low/high-energy SWL protocol was not due to a delayed vasoconstrictor response of pretreatment, as low-energy SW treatment alone (Group 4) did not increase RI until 65 min after SWL.
The pretreatment protocol induces renal vasoconstriction during the period of SW application whereas the standard protocol shows vasoconstriction occurring after SWL. Thus, the earlier and greater rise in RI during the pretreatment protocol may be causally associated with a reduction in tissue injury.
验证低能量冲击波（SW）预处理肾脏比标准临床剂量的高能量SW更早诱导肾血管收缩这一假说，从而为预处理SW碎石术（SWL）方案减少组织损伤提供一种潜在机制。
用异氟烷麻醉6周龄雌性农场猪，使用传统的液电碎石机（HM3，德国多尼尔有限公司）对右肾下极进行SW治疗。采用脉冲多普勒超声测量血管中的肾阻力指数（RI），作为血流阻力/阻抗的指标。从位于肾脏目标极的一条叶内动脉记录RI，测量对象包括接受假SW治疗的猪（第1组；无SW，4头猪）、标准临床剂量的高能量SW治疗的猪（第2组；2000次SW，24 kV，120次SW/分钟，7头猪）、低能量SW预处理后进行高能量SWL的猪（第3组；500次SW，12 kV，120次SW/分钟 + 2000次SW，24 kV，120次SW/分钟，8头猪）以及仅接受低能量SW预处理的猪（第4组；500次SW，12 kV，120次SW/分钟，6头猪）。
所有组的基线RI（约0.61）相似。接受假SW治疗的猪（第1组）RI无显著变化。标准临床剂量的高能量SW（第2组）在治疗期间未显著改变RI，但在SWL后45分钟时RI升高。低能量SW未改变第3组猪的RI，但随后用标准临床剂量的高能量SW治疗导致RI比第2组猪显著更早（在1000次SW时）且更大幅度（两倍）升高。在低/高能量SWL方案期间RI的这种升高并非由于预处理的血管收缩反应延迟，因为仅低能量SW治疗（第4组）直到SWL后65分钟才使RI升高。
预处理方案在SW应用期间诱导肾血管收缩，而标准方案显示血管收缩发生在SWL之后。因此，预处理方案期间RI更早且更大幅度的升高可能与组织损伤的减少存在因果关系。
