Haybron D M, Townsend M C, Hampton W W, Schirmer W J, Schirmer J M, Fry D E
Arch Surg. 1987 Mar;122(3):328-31. doi: 10.1001/archsurg.1987.01400150082016.
Whether acute renal failure following overwhelming bacterial septicemia is a initially a consequence primarily of a cytotoxic insult or a perfusion insufficiency remains unclear. To assess the effects of intra-abdominal sepsis on the distribution of renal blood flow and renal cell bioenergy status, the glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and energy-charge ratios were measured in rats following cecal ligation/puncture (CLP) or sham laparotomies. The CLP animals demonstrated a decrease in ERPF of 42% and 58% from sham groups at ten and 20 hours, respectively. The GFR showed similar but more severe impairments of 53% and 71% at ten and 20 hours, respectively, following insult despite moderate increases in cardiac output. The disproportionate decrease in GFR over ERPF supports the hypothesis of a corticomedullary redistribution of renal blood flow in sepsis. Renal energy charge, unchanged at ten hours, decreased significantly at 20 hours. Diminished renal perfusion and the redistribution of renal blood flow precedes and may contribute to the renal cell bioenergy derangements in septic acute renal failure.
在严重细菌性败血症后发生的急性肾衰竭最初主要是细胞毒性损伤的结果还是灌注不足的结果仍不清楚。为了评估腹腔内脓毒症对肾血流分布和肾细胞生物能状态的影响，在大鼠进行盲肠结扎/穿刺（CLP）或假剖腹手术后，测量了肾小球滤过率（GFR）、有效肾血浆流量（ERPF）和能量电荷比。CLP组动物在术后10小时和20小时时，ERPF分别比假手术组降低了42%和58%。尽管心输出量适度增加，但在损伤后10小时和20小时时，GFR分别出现了类似但更严重的损伤，降低了53%和71%。GFR相对于ERPF的不成比例下降支持了脓毒症时肾血流发生皮质-髓质重新分布的假说。肾脏能量电荷在10小时时无变化，但在20小时时显著下降。在脓毒症急性肾衰竭中，肾灌注减少和肾血流重新分布先于肾细胞生物能紊乱发生，并且可能是其原因之一。
