Kopitkó Csaba, Medve László, Gondos Tibor, Soliman Karim Magdy Mohamed, Fülöp Tibor
Department of Anesthesiology and Intensive Therapy, Uzsoki Teaching Hospital, Semmelweis University, H-1145 Budapest, Hungary.
Department of Anesthesiology and Intensive Therapy, Markhot Ferenc Teaching Hospital, H-3300 Eger, Hungary.
J Clin Med. 2022 May 12;11(10):2728. doi: 10.3390/jcm11102728.
Acute kidney injury (AKI), especially if recurring, represents a risk factor for future chronic kidney disease. In intensive care units, increased intra-abdominal pressure is well-recognized as a significant contributor to AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades. Unlike the well-known autoregulation of the renal cortical circulation, medulla perfusion is modulated via partially independent regulatory mechanisms and strongly impacted by changes in venous and lymphatic pressures. In our review paper, we will provide a comprehensive overview of this evolving topic, covering a broad range from basic pathophysiology up to and including current clinical relevance and examples. Key regulators of oxidative stress such as ischemia-reperfusion injury, the activation of inflammatory response and humoral changes interacting with procedural pneumo-peritoneum formation and AKI risk will be recounted. Moreover, we present an in-depth review of the interaction of pneumo-peritoneum formation with general anesthetic agents and animal models of congestive heart failure. A better understanding of the relationship between pneumo-peritoneum formation and renal perfusion will support basic and clinical research, leading to improved clinical care and collaboration among specialists.
急性肾损伤（AKI），尤其是反复发生的急性肾损伤，是未来发生慢性肾病的一个危险因素。在重症监护病房，腹腔内压力升高被公认为是导致急性肾损伤的一个重要因素。然而，在腹腔镜手术中，短暂性腹腔内压力升高的重要性却较少受到重视，而在过去几十年里，腹腔镜手术的使用迅速增加。与众所周知的肾皮质循环自动调节不同，髓质灌注是通过部分独立的调节机制进行调节的，并且受到静脉和淋巴压力变化的强烈影响。在我们的综述论文中，我们将对这个不断发展的主题进行全面概述，涵盖从基本病理生理学到当前临床相关性及实例等广泛内容。将阐述氧化应激的关键调节因子，如缺血再灌注损伤、炎症反应激活以及与手术气腹形成和急性肾损伤风险相互作用的体液变化。此外，我们对气腹形成与全身麻醉剂以及充血性心力衰竭动物模型之间的相互作用进行了深入综述。更好地理解气腹形成与肾灌注之间的关系将有助于基础和临床研究，从而改善临床护理以及专家之间的协作。
