Lee Franklin C, Hsi Ryan S, Sorensen Mathew D, Paun Marla, Dunmire Barbrina, Liu Ziyue, Bailey Michael, Harper Jonathan D
1 Department of Urology, University of Washington School of Medicine , Seattle, Washington.
2 Division of Urology, Department of Veteran Affairs Medical Center , Seattle, Washington.
J Endourol. 2015 Dec;29(12):1392-5. doi: 10.1089/end.2015.0315. Epub 2015 Oct 26.
In animal models, pretreatment with low-energy shock waves and a pause decreased renal injury from shockwave lithotripsy (SWL). This is associated with an increase in perioperative renal resistive index (RI). A perioperative rise is not seen without the protective protocol, which suggests that renal vasoconstriction during SWL plays a role in protecting the kidney from injury. The purpose of our study was to investigate whether there is an increase in renal RI during SWL in humans.
Subjects were prospectively recruited from two hospitals. All subjects received an initial 250 shocks at low setting, followed by a 2-minute pause. Treatment power was then increased. Measurements of the renal RI were taken before start of procedure, at 250, after 750, after 1500 shocks, and at the end of the procedure. A linear mixed-effects model was used to compare RIs at the different time points.
Fifteen patients were enrolled. Average treatment time was 46 ± 8 minutes. Average RI at pretreatment, after 250, after 750, after 1500 shocks, and post-treatment was 0.67 ± 0.06, 0.69 ± 0.08, 0.71 ± 0.07, 0.73 ± 0.07, and 0.74 ± 0.06, respectively. In adjusted analyses, RI was significantly increased after 750 shocks compared with pretreatment (p = 0.05).
Renal RI increases early during SWL in humans with the protective protocol. Monitoring for a rise in RI during SWL is feasible and may provide real-time feedback as to when the kidney is protected.
在动物模型中，低能量冲击波预处理并暂停可减少冲击波碎石术（SWL）所致的肾损伤。这与围手术期肾阻力指数（RI）升高有关。若无保护方案则未见围手术期RI升高，这表明SWL期间的肾血管收缩在保护肾脏免受损伤中起作用。我们研究的目的是调查人类SWL期间肾RI是否升高。
前瞻性地从两家医院招募受试者。所有受试者先在低能量设置下接受250次冲击，随后暂停2分钟。然后增加治疗能量。在手术开始前、250次冲击后、750次冲击后、1500次冲击后以及手术结束时测量肾RI。使用线性混合效应模型比较不同时间点的RI。
纳入15例患者。平均治疗时间为46±8分钟。预处理时、250次冲击后、750次冲击后、1500次冲击后以及治疗后的平均RI分别为0.67±0.06、0.69±0.08、0.71±0.07、0.73±0.07和0.74±0.06。在校正分析中，与预处理相比，750次冲击后RI显著升高（p = 0.05）。
采用保护方案时，人类SWL期间肾RI早期升高。SWL期间监测RI升高是可行的，并且可能提供肾脏何时受到保护的实时反馈。
