University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
J Endourol. 2010 Mar;24(3):321-5. doi: 10.1089/end.2009.0184.
Renal artery-only (AO) occlusion, as opposed to artery and vein (AV) occlusion, has demonstrated some benefit in reducing renal insufficiency during warm ischemia. In this pilot study, we used digital light projection hyperspectral imaging (HSI) to construct a "real time" tissue oxygenation "map" to determine whether there are differences in renal tissue oxygenation during vascular occlusion with AO vs AV.
Renal vascular occlusion with either AO or AV was performed for 60 minutes in seven porcine renal units. Using HSI, the percentage of oxyhemoglobin (%HbO(2)) in the renal cortex was determined at 4-minute increments throughout the ischemic period and for 30 minutes after reperfusion.
Average baseline %HbO(2) in all animals was approximately 70%. After vascular occlusion in both cohorts, %HbO(2) decreased by one third within 2 to 5 minutes, with a gradual decline in %HbO(2) over the remaining 55 minutes. Oxyhemoglobin profiles for AO and AV occlusion diverged significantly between 16 and 24 minutes after vascular occlusion (P = 0.0001 and 0.036, respectively), with a merging of the two curves occurring after approximately 36 minutes (P = 0.093). During reperfusion, average %HbO(2) improved to 72.4% after 25 to 30 minutes.
In this pilot study, we demonstrate that renal tissue oxygenation drops rapidly after occlusion of the renal vasculature and returns to near baseline 30 minutes after reperfusion. In the porcine model, the %HbO(2) differs significantly between AO and AV occlusion for up to 35 minutes after ischemia onset, indicating a possible "ischemic window" in which AO occlusion may provide benefit over AV occlusion.
与血管和静脉（AV）闭塞相比，仅肾动脉闭塞（AO）在减少热缺血期间肾功能不全方面显示出一些益处。在这项初步研究中，我们使用数字光投影高光谱成像（HSI）构建了一个“实时”组织氧合“图”，以确定在 AO 与 AV 血管闭塞期间肾组织氧合是否存在差异。
在 7 个猪肾单位中进行 AO 或 AV 肾血管闭塞 60 分钟。在整个缺血期间，每隔 4 分钟使用 HSI 确定肾皮质中的氧合血红蛋白百分比（%HbO(2)），并在再灌注后 30 分钟进行测量。
所有动物的平均基线%HbO(2)约为 70%。在两组动物中，血管闭塞后 2 至 5 分钟内%HbO(2)下降了三分之一，其余 55 分钟内%HbO(2)逐渐下降。在血管闭塞后 16 至 24 分钟，AO 和 AV 闭塞的氧合血红蛋白曲线明显分离（分别为 P = 0.0001 和 0.036），大约 36 分钟后两条曲线合并（P = 0.093）。在再灌注期间，平均%HbO(2)在 25 至 30 分钟后恢复到 72.4%。
在这项初步研究中，我们证明肾组织氧合在肾血管闭塞后迅速下降，再灌注 30 分钟后恢复接近基线水平。在猪模型中，在缺血发作后长达 35 分钟内，AO 与 AV 闭塞之间的%HbO(2)存在显著差异，表明存在可能的“缺血窗”，在该窗内 AO 闭塞可能比 AV 闭塞更有益。
