Haybron D M, Townsend M C, Hampton W W, Schirmer J M, Fry D E
Am Surg. 1986 Dec;52(12):625-9.
The temporal sequence of physiological derangements preceding acute renal failure (ARF) observed in overwhelming bacterial septicemia remains controversial. In order to examine the relationship of renal circulatory alterations and cellular dysfunction in murine sepsis, effective renal plasma flow (ERPF), renal tissue metabolites, and energy charge ratios were determined in Sprague-Dawley rats at 10 and 20 hours following induction of peritonitis by cecal ligation and perforation (CLP) or cecal manipulation alone (sham). Tissue levels of adenine nucleotides, lactate, and pyruvate were assayed after freeze-clamping kidneys unilaterally followed by enzymatic determinations. Cardiac outputs were determined by thermodilution and ERPF by p-aminohippuric acid (PAH) clearance. Results indicate in this model, despite an increase in cardiac output (P less than 0.05), ERPF was significantly decreased at both 10 hours (P less than; 0.05) and 20 hours (P less than 0.01) following induction of peritonitis. Further, although tissue pyruvate/lactate ratios showed significant decreases by 10 hours (P less than 0.05), diminished energy charge ratios were not observed until 20 hours following septic insult. These findings support the hypothesis of diminished renal perfusion as contributory and antecedent to cellular dysfunction in septicemic ARF.
在严重细菌性败血症中观察到的急性肾衰竭（ARF）之前生理紊乱的时间顺序仍存在争议。为了研究小鼠脓毒症中肾循环改变与细胞功能障碍之间的关系，在通过盲肠结扎和穿孔（CLP）或仅进行盲肠操作（假手术）诱导腹膜炎后10小时和20小时，测定了Sprague-Dawley大鼠的有效肾血浆流量（ERPF）、肾组织代谢物和能量电荷比。在单侧冷冻钳夹肾脏后，通过酶法测定腺嘌呤核苷酸、乳酸和丙酮酸的组织水平。通过热稀释法测定心输出量，通过对氨基马尿酸（PAH）清除率测定ERPF。结果表明，在该模型中，尽管心输出量增加（P<0.05），但在诱导腹膜炎后10小时（P<0.05）和20小时（P<0.01），ERPF均显著降低。此外，尽管组织丙酮酸/乳酸比值在10小时时显著降低（P<0.05），但直到脓毒症损伤后20小时才观察到能量电荷比降低。这些发现支持了肾灌注减少是败血性ARF中细胞功能障碍的原因和前提这一假说。
