在麻醉兔的肾缺血期间,多种机制共同作用以维持肾脏的氧合。

Multiple mechanisms act to maintain kidney oxygenation during renal ischemia in anesthetized rabbits.

机构信息

Dept. of Physiology, PO Box 13F, Monash Univ., Victoria 3800, Australia.

出版信息

Am J Physiol Renal Physiol. 2010 May;298(5):F1235-43. doi: 10.1152/ajprenal.00647.2009. Epub 2010 Mar 3.

Abstract

We examined the mechanisms that maintain stable renal tissue PO(2) during moderate renal ischemia, when changes in renal oxygen delivery (DO(2)) and consumption (VO(2)) are mismatched. When renal artery pressure (RAP) was reduced progressively from 80 to 40 mmHg, VO(2) (-38 ± 7%) was reduced more than DO(2) (-26 ± 4%). Electrical stimulation of the renal nerves (RNS) reduced DO(2) (-49 ± 4% at 2 Hz) more than VO(2) (-30 ± 7% at 2 Hz). Renal arterial infusion of angiotensin II reduced DO(2) (-38 ± 3%) but not VO(2) (+10 ± 10%). Despite mismatched changes in DO(2) and VO(2), renal tissue PO(2) remained remarkably stable at ≥40 mmHg RAP, during RNS at ≤2 Hz, and during angiotensin II infusion. The ratio of sodium reabsorption to VO(2) was reduced by all three ischemic stimuli. None of the stimuli significantly altered the gradients in PCO(2) or pH across the kidney. Fractional oxygen extraction increased and renal venous PO(2) fell during 2-Hz RNS and angiotensin II infusion, but not when RAP was reduced to 40 mmHg. Thus reduced renal VO(2) can help prevent tissue hypoxia during mild renal ischemia, but when renal VO(2) is reduced less than DO(2), other mechanisms prevent a fall in renal PO(2). These mechanisms do not include increased efficiency of renal oxygen utilization for sodium reabsorption or reduced washout of carbon dioxide from the kidney, leading to increased oxygen extraction. However, increased oxygen extraction could be driven by altered countercurrent exchange of carbon dioxide and/or oxygen between renal arteries and veins.

摘要

我们研究了在中度肾缺血期间维持稳定的肾组织 PO(2)的机制,此时肾氧输送 (DO(2)) 和消耗 (VO(2)) 的变化不匹配。当肾动脉压 (RAP) 从 80mmHg 逐渐降至 40mmHg 时,VO(2) (-38±7%) 的降低幅度大于 DO(2) (-26±4%)。肾神经电刺激 (RNS) 使 DO(2) (-49±4%,2Hz) 的降低幅度大于 VO(2) (-30±7%,2Hz)。肾动脉内输注血管紧张素 II 可降低 DO(2) (-38±3%),但不影响 VO(2) (+10±10%)。尽管 DO(2) 和 VO(2) 的变化不匹配,但在 RAP≥40mmHg 时、在≤2Hz 的 RNS 期间以及在血管紧张素 II 输注期间,肾组织 PO(2) 仍保持非常稳定。三种缺血性刺激均降低了钠重吸收与 VO(2) 的比值。这三种刺激均未显著改变肾脏跨皮梯度的 PCO(2) 或 pH 值。在 2Hz 的 RNS 和血管紧张素 II 输注期间,氧摄取分数增加,肾静脉 PO(2) 降低,但当 RAP 降至 40mmHg 时则不然。因此,在轻度肾缺血期间,减少肾 VO(2) 有助于防止组织缺氧,但当肾 VO(2) 的减少小于 DO(2) 时,其他机制可防止肾 PO(2) 下降。这些机制不包括增加钠重吸收的肾氧利用效率或减少二氧化碳从肾脏洗脱,导致氧摄取增加。然而,氧摄取的增加可能是由肾动、静脉之间的二氧化碳和/或氧逆流交换的改变驱动的。

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