Nishiwaki H, Ko I, Hiura A, Ha S S, Satake K, Sowa M
First Department of Surgery, Osaka City University Medical School, Japan.
Ren Fail. 1993;15(1):27-31. doi: 10.3109/08860229309065568.
In order to understand the mechanism of acute renal failure frequently observed in severe acute pancreatitis, renal microcirculation and renal hemodynamics were investigated during experimental acute pancreatitis in dogs induced by autologous bile and trypsin mixture into the pancreatic duct. Renal tissue blood flow (hydrogen gas clearance method), renal arterial blood flow, and cardiac output (transonic blood flow meter) were each measured for 5 h after induction of pancreatitis. The effect on renal hemodynamics of a new synthesized protease inhibitor--E-3123; 4-(2-succinimidoethylthio)phenyl-4-quanidinobenzoate methane sulfonate--intravenously infused at the rate of 3 mg/kg/h was also investigated. The mean blood pressure and pulse pressure decreased after induction of pancreatitis. Renal microcirculation and renal artery blood flow decreased during the experiment. However, in dogs with treated by E-3123, renal microcirculation was preserved during the first hour of the experiment and decreased gradually afterward, but it was significantly higher than that of the dogs without E-3123 during 3-5 h. The mean blood pressure and pulse pressure were preserved nearly at preoperative levels during the experimental period. We concluded that renal microcirculation decreased concomitantly with a deterioration of acute pancreatitis, and that the new pancreatic protease inhibitor E-3123 may have some beneficial effect to improve renal hemodynamics in the early period of acute pancreatitis.
为了解重症急性胰腺炎中常见的急性肾衰竭机制，在通过将自体胆汁和胰蛋白酶混合物注入犬胰管诱导的实验性急性胰腺炎过程中，对肾脏微循环和肾血流动力学进行了研究。胰腺炎诱导后5小时内，分别测量肾组织血流量（氢气清除法）、肾动脉血流量和心输出量（跨音速血流仪）。还研究了以3mg/kg/h的速率静脉输注新合成的蛋白酶抑制剂——E-3123；4-（2-琥珀酰亚胺基乙硫基）苯基-4-胍基苯甲酸盐甲磺酸盐——对肾血流动力学的影响。胰腺炎诱导后平均血压和脉压下降。实验过程中肾脏微循环和肾动脉血流量减少。然而，用E-3123治疗的犬，在实验的第一小时肾脏微循环得以保留，之后逐渐下降，但在3至5小时期间明显高于未用E-3123治疗的犬。实验期间平均血压和脉压几乎维持在术前水平。我们得出结论，肾脏微循环随着急性胰腺炎的恶化而降低，新的胰腺蛋白酶抑制剂E-3123可能在急性胰腺炎早期对改善肾血流动力学有一些有益作用。
