Vianna P T G, Castiglia Y M M, Braz J R C, Viero R M, Beier S, Vianna Filho P T G, Vitória A, Reinoldes Bizarria Guilherme G, de Assis Golim M, Deffune E
Department of Anesthesiology, Botucatu School of Medicine, São Paulo State University, São Paulo, Brazil.
Transplant Proc. 2009 Dec;41(10):4080-2. doi: 10.1016/j.transproceed.2009.09.078.
The purpose of this investigation was to examine the effect of isoflurane, remifentanil, and preconditioning in renal ischemia/reperfusion injury (IRI).
All 52 male Wistar rats were anesthetized with isoflurane, intubated and mechanically ventilated. The animals were randomly divided into: S group (sham; n = 11) that underwent only right nephrectomy; as well as the I group of right nephrectomy and ischemia for 45 minutes by clamping of left renal artery. (n = 11); the IP (n = 9), the R (n = 10), and the RP (n = 11) groups. In addition, the R and RP animals received remifentanil (2 microg.kg(-1).min(-1)) during the entire experiment. The IP and RP group underwent ischemic preconditioning (IPC = three cycles of 5 minutes). Serum creatinine values were determined before and after IRI, as well as 24 hours later. In addition to an Histological study, cells from the left kidney were evaluated for apoptosis by flow cytometry (FCM).
The Creatinine value of 0.8 +/- 0.2 mg/dl in the S group was significantly lower at 24 hours than the I 3.9 +/- 1.5 mg/dl; IP 2.6 +/- 1.7 mg/dl; R 3.3 +/- 2.8 mg/dl; or RP 1.8 +/- 0.5 mg/dl groups. The RP group value was significantly lower than those of the I, IP, and R groups (p < 0.05). The S group showed less proximal tubular cell damage than the I, IP, R, and RP groups (p < 0.05). The percentages of apoptotic cells (FITC(+)/PI(-)) were: S group = 11.6 +/- 6.5; I = 16.7 +/- 7.3; IP = 37.0 +/- 28.4; R = 11.7 +/- 6.6, and RP = 8.8 +/- 1.5. The difference between the IP vs RP group was significant. Similar percentages of necrotic cells (FITC(+)/PI(+)) and intact cells (FITC(-)/PI(-)) were observed among the groups.
Ischemic preconditioning showed no protective effect in the isoflurane group (IP) but when isoflurane was administered associated with remifentanil (RP), there was a beneficial effect on the kidney, as demonstrated by flow cytometry and serum creatinine values.
本研究旨在探讨异氟烷、瑞芬太尼及预处理对肾缺血/再灌注损伤（IRI）的影响。
52只雄性Wistar大鼠用异氟烷麻醉，插管并机械通气。动物随机分为：S组（假手术组；n = 11），仅行右肾切除术；I组（右肾切除并通过夹闭左肾动脉缺血45分钟；n = 11）；IP组（n = 9）、R组（n = 10）和RP组（n = 11）。此外，R组和RP组动物在整个实验过程中接受瑞芬太尼（2微克·千克⁻¹·分钟⁻¹）。IP组和RP组进行缺血预处理（IPC = 5分钟的三个周期）。在IRI前后及24小时后测定血清肌酐值。除组织学研究外，通过流式细胞术（FCM）评估左肾细胞的凋亡情况。
S组24小时时肌酐值为0.8±0.2毫克/分升，显著低于I组的3.9±1.5毫克/分升、IP组的2.6±1.7毫克/分升、R组的3.3±2.8毫克/分升或RP组的1.8±0.5毫克/分升。RP组的值显著低于I组、IP组和R组（p < 0.05）。S组近端肾小管细胞损伤少于I组、IP组、R组和RP组（p < 0.05）。凋亡细胞（FITC(+)/PI(-)）的百分比为：S组 = 11.6±6.5；I组 = 16.7±7.3；IP组 = 37.0±28.4；R组 = 11.7±6.6，RP组 = 8.8±1.5。IP组与RP组之间的差异显著。各组间坏死细胞（FITC(+)/PI(+)）和完整细胞（FITC(-)/PI(-)）的百分比相似。
缺血预处理在异氟烷组（IP）中未显示出保护作用，但当异氟烷与瑞芬太尼联合应用时（RP），对肾脏有有益作用，这通过流式细胞术和血清肌酐值得到证实。
