Le Jemtel T H, Maskin C S, Chadwick B
Am J Med Sci. 1986 Sep;292(3):123-7. doi: 10.1097/00000441-198609000-00001.
Renal blood flow was serially measured as the left renal vein blood flow using the continuous thermodilution technique during acute angiotensin converting enzyme inhibition in 20 patients with stable congestive heart failure. Eleven patients received captopril orally, and the remaining nine patients received enalaprilat intravenously. During the control period, left renal vein blood flow and cardiac output did not correlate closely (r = 0.57). Following administration of captopril or enalaprilat, stroke volume index increased from 20 +/- 7 to 25 +/- 8 ml/M2 (p less than 0.001), while pulmonary capillary wedge pressure decreased from 26 +/- 8 to 19 +/- 8 mm Hg (p less than 0.001). Left renal vein blood flow increased in all patients despite a consistent reduction in systemic arterial pressure. At peak effect, left renal vein blood flow increased from 295 +/- 86 to 443 +/- 122 ml/min (p less than 0.001), while mean systemic arterial pressure fell from 81 +/- 13 to 71 +/- 14 mm Hg (p less than 0.001). Thus, in patients with stable congestive heart failure, acute angiotensin converting enzyme inhibition, although decreasing substantially systemic arterial pressure, consistently enhances renal blood flow.
在20例稳定型充血性心力衰竭患者中，采用连续热稀释技术，在急性血管紧张素转换酶抑制期间，连续测量肾血流量作为左肾静脉血流量。11例患者口服卡托普利，其余9例患者静脉注射依那普利拉。在对照期，左肾静脉血流量与心输出量无密切相关性（r = 0.57）。给予卡托普利或依那普利拉后，每平方米体表面积的每搏量指数从20±7增加至25±8 ml/M2（p<0.001），而肺毛细血管楔压从26±8降至19±8 mmHg（p<0.001）。尽管全身动脉压持续降低，但所有患者的左肾静脉血流量均增加。在效应峰值时，左肾静脉血流量从295±86增加至443±122 ml/min（p<0.001），而平均全身动脉压从81±13降至71±14 mmHg（p<0.001）。因此，在稳定型充血性心力衰竭患者中，急性血管紧张素转换酶抑制虽然会使全身动脉压大幅下降，但仍能持续增加肾血流量。
