吲哚美辛输注对猪单侧输尿管梗阻期间肾血流动力学及肾素-血管紧张素系统的影响。

The effect of indomethacin infusion on renal hemodynamics and on the renin-angiotensin system during unilateral ureteral obstruction of the pig.

作者信息

Frøkiaer J, Nielsen A S, Knudsen L, Djurhuus J C, Pedersen E B

机构信息

Institute of Experimental Clinical Research, Skejby University Hospital, Aarhus, Denmark.

出版信息

J Urol. 1993 Nov;150(5 Pt 1):1557-63. doi: 10.1016/s0022-5347(17)35841-x.

DOI:10.1016/s0022-5347(17)35841-x

PMID:8411451

Abstract

Obstruction of the urinary tract is associated with an increase in pelvic pressure (PP) and a decline in ipsilateral renal blood flow (RBF). To investigate the influence of the renal prostaglandins on these parameters, pigs with complete unilateral ureteral obstruction (UUO) were studied under general anesthesia after administration of indomethacin 30 minutes before obstruction. Pelvic pressure increased to a maximum of 41.1 +/- 2.4 cm. H2O after 6 hours, but maximum pressure, as well as the rate of pressure increase, was significantly reduced after indomethacin. A transient but significant increase in mean aortic blood pressure was seen, together with a bilateral decrease in RBF immediately after indomethacin administration. Ipsilaterally RBF decreased by 25% from 319 +/- 21 ml. per minute to 237 +/- 16 ml. per minute and contralaterally by 23% from 300 +/- 20 ml. per minute to 231 +/- 25 ml. per minute. After 15 hours a further decline was measured in ipsilateral RBF to 136 +/- 20 ml. per minute but, on the contralateral side, RBF was only slightly reduced to 281 +/- 36 ml. per minute after 15 hours. Following indomethacin a sustained increase in ipsilateral renal vascular resistance (RVR) was observed from 37.6 +/- 3.6 mm. Hg x ml.-1 x min. x gm. to 130.5 +/- 42.3 mm. Hg x ml.-1 x min. x gm. compared with a much smaller increase from 37.4 +/- 3.2 mm. Hg x ml.-1 x min. x gm. to 55.1 +/- 9.2 mm. Hg x ml.-1 x min. x gm. in the control group. Renal secretion rate of angiotensin II was significantly reduced 2 and 6 hours after indomethacin administration on the obstructed side, and was not significantly changed on the contralateral side. It can be concluded that inhibition of prostaglandin synthesis during unilateral ureteral obstruction in pigs results in reduced pelvic pressure, renal blood flow and angiotensin II secretion rate from the affected kidney, and that renal prostaglandin synthesis plays an important role for the perfusion of the kidney during ureteral obstruction.

摘要

尿路梗阻与盆腔压力（PP）升高及同侧肾血流量（RBF）下降有关。为研究肾前列腺素对这些参数的影响，在梗阻前30分钟给予吲哚美辛后，对完全性单侧输尿管梗阻（UUO）的猪进行全身麻醉下的研究。盆腔压力在6小时后升至最高41.1±2.4 cmH₂O，但吲哚美辛给药后，最大压力以及压力升高速率均显著降低。给药后立即出现平均主动脉血压短暂但显著升高，同时RBF双侧下降。同侧RBF从319±21 ml/分钟降至237±16 ml/分钟，下降25%，对侧从300±20 ml/分钟降至231±25 ml/分钟，下降23%。15小时后，同侧RBF进一步降至136±20 ml/分钟，但对侧15小时后RBF仅轻微降至281±36 ml/分钟。给予吲哚美辛后，同侧肾血管阻力（RVR）持续升高，从37.6±3.6 mmHg·ml⁻¹·min·g升至130.5±42.3 mmHg·ml⁻¹·min·g，而对照组从37.4±3.2 mmHg·ml⁻¹·min·g升至55.1±9.2 mmHg·ml⁻¹·min·g，升高幅度小得多。吲哚美辛给药后2小时和6小时，梗阻侧肾血管紧张素II分泌率显著降低，对侧无显著变化。可以得出结论，猪单侧输尿管梗阻期间前列腺素合成的抑制导致盆腔压力、肾血流量以及患侧肾血管紧张素II分泌率降低，并且肾前列腺素合成在输尿管梗阻期间对肾脏灌注起重要作用。