Department of Urology L, University Hospital of Southern Denmark, Odense, Denmark.
BJU Int. 2010 Jan;105(1):121-4. doi: 10.1111/j.1464-410X.2009.08678.x. Epub 2009 Jun 24.
To investigate the effects on the pressure-flow relation of renal pelvic pressure during semirigid ureterorenoscopy and endoluminal perfusion of isoproterenol (ISO) 0.1 microg/mL, with emphasis on local effects and cardiovascular side-effects, as topically administered ISO effectively and dose-dependently causes relaxation of the upper urinary tract in pigs with no concomitant cardiovascular side-effects.
In anaesthetized female pigs (60 kg), 16 macroscopically normal upper urinary tract systems were subjected to ureterorenoscopy. Via a subcostal incision a 6-F catheter was placed in the renal pelvis for pressure measurements, and a semirigid ureteroscope (7.8 F) was inserted retrogradely in the renal pelvis, through which the pelvis was perfused. The blood pressure and heart rate were recorded. The increase in renal pelvic pressure was examined with increasing flow rates (0, 4, 8, 12, 16, 25 and 33 mL/min) with saline alone or saline + ISO 0.1 microg/mL. Perfusion was initiated on the left side, with randomization for adding ISO or not. Thereafter perfusion was done on the right side as a control in each pig. The surgeons were unaware of whether ISO was added or not.
The mean (sd) baseline pelvic pressures in the saline and ISO group were 28 (7.1) and 25 (9.8) mmHg, respectively, with no significant difference (P = 0.079). Endoluminal perfusion with ISO significantly inhibited the pelvic pressure increase to perfusion at all perfusion rates. The pressure-flow relation was linear; the maximum relaxation (27%) was obtained at 4 mL/min, from 52 to 38 mmHg during saline alone and ISO 0.1 microg/mL perfusion, respectively. The mean blood pressure did not change significantly (P = 0.330). The mean (sd) heart rate in the saline and ISO group were 109 (4.5) and 97 (2.1) beats/min, respectively (P < 0.001), i.e. a markedly greater rate in the saline than in the ISO group.
The pressure-flow relation during semirigid ureterorenoscopy was linear. ISO 0.1 microg/mL in saline significantly reduced the pressure-flow relation during semirigid ureterorenoscopy in this porcine model. ISO might be a potential additive to the irrigation fluid during upper urinary tract endoscopic procedures, minimizing pressure increases due to irrigation and manipulation.
研究异丙肾上腺素（ISO）0.1μg/mL 经肾盂内局部给药对内窥镜下肾盂压力-流率关系的影响，重点探讨局部作用和心血管副作用。ISO 可有效且剂量依赖性地松弛猪的上尿路，且无伴随的心血管副作用。
在 60kg 麻醉雌性猪中，16 个肉眼正常的上尿路系统接受输尿管镜检查。通过肋缘下切口，将 6-F 导管放置在肾盂中进行压力测量，并通过逆行插入半刚性输尿管镜（7.8F）将肾盂内灌注。记录血压和心率。单独用生理盐水或生理盐水+0.1μg/mL ISO 增加流量（0、4、8、12、16、25 和 33mL/min）时，检查肾盂压力的增加。左侧开始灌注，随机添加或不添加 ISO。此后，在每只猪中作为对照，在右侧进行灌注。外科医生不知道是否添加了 ISO。
生理盐水和 ISO 组的平均（标准差）基础肾盂压力分别为 28（7.1）和 25（9.8）mmHg，无显著差异（P=0.079）。ISO 腔内灌注显著抑制了所有灌注率下肾盂压力的增加。压力-流率关系呈线性；单独用生理盐水灌注时，肾盂压力从 52mmHg 降至 38mmHg，最大松弛（27%）发生在 4mL/min；ISO 0.1μg/mL 灌注时，肾盂压力从 52mmHg 降至 38mmHg，最大松弛（27%）发生在 4mL/min。平均血压无显著变化（P=0.330）。生理盐水和 ISO 组的平均（标准差）心率分别为 109（4.5）和 97（2.1）次/分钟（P<0.001），即生理盐水组的心率明显快于 ISO 组。
半刚性输尿管镜检查期间的压力-流率关系呈线性。在这种猪模型中，生理盐水 0.1μg/mL ISO 显著降低了半刚性输尿管镜检查期间的压力-流率关系。ISO 可能是上尿路内镜手术中冲洗液的潜在添加剂，可最大程度地减少因冲洗和操作引起的压力升高。
