Nishiwaki H, Koh I, Kanazawa G, Hiura A, Satake K, Umeyama K
First Department of Surgery, Osaka City University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1988 Dec;89(12):1990-6.
To understand the renal microcirculation in acute pancreatitis is important to know the pathophysiology of renal insufficiency frequently observed as one of multiple organ failures in severe acute pancreatitis. In mongrel dogs acute pancreatitis was experimentally introduced by autologous bile added trypsin injection into the pancreatic duct. The effect of new synthesized pancreatic protease inhibitor (PATM) and dopamine in a dose of 3mg/kg/hr and 10 micrograms/kg/min were investigated, respectively. In acute pancreatitis dogs, renal arterial blood flow and renal tissue blood flow immediately fell and gradually decreased in time course of experiment and renal vascular resistance increased from 2 hours after onset of pancreatitis. When pancreatic protease inhibitor (PATM) was infused in acute pancreatitis dogs, blood pressure and pulse pressure relatively preserved during the experiment. Renal blood flow and renal tissue blood flow were maintained during the first 1 hour and thereafter slightly decreased, however which was less than that of no PATM treated dogs. When dopamine was infused in acute pancreatitis dogs, blood pressure was maintained during the first 90 minutes thereafter remarkably decreased. Renal blood flow was maintained within 60 minutes, however it remarkably decreased at the end of the experiment. This study suggested that renal microcirculation was disturbed from early period of acute pancreatitis in dogs and pancreatic protease inhibitor (PATM) had a beneficial effect of maintain the renal microcirculation.
了解急性胰腺炎时的肾脏微循环对于认识重症急性胰腺炎中常见的作为多器官功能衰竭之一的肾功能不全的病理生理学很重要。在杂种狗中，通过向胰管内注射自体胆汁加胰蛋白酶来实验性诱发急性胰腺炎。分别研究了新合成的胰蛋白酶抑制剂（PATM）以及剂量为3mg/kg/hr的多巴胺和10微克/kg/min的多巴胺的作用。在急性胰腺炎狗中，肾动脉血流和肾组织血流在实验开始时立即下降，并随时间逐渐减少，肾血管阻力从胰腺炎发作后2小时开始增加。当向急性胰腺炎狗输注胰蛋白酶抑制剂（PATM）时，实验期间血压和脉压相对保持稳定。肾血流和肾组织血流在最初1小时内得以维持，此后略有下降，然而下降程度小于未用PATM治疗的狗。当向急性胰腺炎狗输注多巴胺时，血压在最初90分钟内得以维持，此后显著下降。肾血流在60分钟内得以维持，但在实验结束时显著下降。本研究提示，狗在急性胰腺炎早期肾脏微循环就受到干扰，而胰蛋白酶抑制剂（PATM）对维持肾脏微循环具有有益作用。
