Department of Nephrology, University of São Paulo-School of Medicine, São Paulo, Brazil.
J Surg Res. 2012 Jun 15;175(2):312-5. doi: 10.1016/j.jss.2011.05.052. Epub 2011 Jun 23.
Acute kidney injury (AKI) following prolonged laparoscopy is a documented phenomenon. Carbon dioxide pneumoperitoneum induces oxidative stress. Previous experimental studies have shown that the antioxidant, N-acetylcysteine, protects the rat from AKI following ischemia-reperfusion. The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) on rat renal function after prolonged pneumoperitoneum.
Normal rats treated or not with NAC were submitted to abdominal CO(2) insufflation of 10 mmHg, at short and long periods of time of 1 and 3 h, respectively, and evaluated at 24, 72 h, and 1 wk after deinsufflation. Glomerular filtration rate (GFR) was measured by inulin clearance and oxidative stress was evaluated by serum thiobarbituric acid reactive substances (TBARS) RESULTS: No significant alterations in GFR were observed in normal animals submitted to the pneumoperitoneum of 1 h and evaluated after 24 h desufflation. With 3 h of pneumoperitoneum, a significant and progressive decrease in GFR occurred 24 and 72 h after desufflation with an increase in serum TBARS. GFR returned to normal levels a week later. In the NAC-treated rats, a complete protection against GFR drops was observed 24 and 72 h following 3 h of pneumoperitoneum associated with a decrease in TBARS.
These results suggest that NAC protects against acute kidney injury following prolonged pneumoperitoneum. These findings have significant clinical implications.
长时间腹腔镜手术后发生急性肾损伤（AKI）是已证实的现象。二氧化碳气腹会引起氧化应激。先前的实验研究表明，抗氧化剂 N-乙酰半胱氨酸（NAC）可保护大鼠免受缺血再灌注后 AKI 的影响。本研究旨在评估 N-乙酰半胱氨酸（NAC）对长时间气腹后大鼠肾功能的影响。
正常大鼠用或不用 NAC 处理，分别接受短时间（1 小时）和长时间（3 小时）的腹腔 CO2 充气，分别在充气后 24、72 小时和 1 周进行评估。肾小球滤过率（GFR）通过菊粉清除率进行测量，氧化应激通过血清硫代巴比妥酸反应物质（TBARS）进行评估。
正常动物在接受 1 小时气腹并在 24 小时放气后进行评估时，GFR 没有明显变化。在接受 3 小时气腹的动物中，放气后 24 和 72 小时 GFR 出现显著且进行性下降，血清 TBARS 增加。一周后 GFR 恢复正常水平。在 NAC 治疗的大鼠中，在接受 3 小时气腹后 24 和 72 小时，GFR 下降完全得到保护，同时 TBARS 下降。
这些结果表明，NAC 可预防长时间气腹后急性肾损伤。这些发现具有重要的临床意义。
