Nakatani T, Sakamoto Y, Ando H, Kobayashi K
Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo, Japan.
Surgery. 1996 Jun;119(6):684-9. doi: 10.1016/s0039-6060(96)80193-0.
The blood levels of ketone bodies, which are synthesized principally in the liver, were maintained even during hepatic inflow occlusion if Ringer's acetate solution (AR) was administered, resulting in an improvement of hepatic energy level in the reperfusion phase, as reported in our previous experimental study. The current study was designed to prove that the kidneys are the organs that contribute to synthesize ketone bodies during hepatic inflow occlusion if AR is administered.
The arterial, central venous, renal venous, and renal tissue ketone body concentrations were determined in rabbits administered AR or Ringer's lactate solution (LR) at 20 minutes of hepatic ischemia and at 30 minutes of reperfusion. The concentrations were also compared in rabbits under AR infusion with or without hepatic ischemia for 20 minutes. Statistical analyses were performed by means of ANOVA:
With AR the renal venous ketone body concentration not only was higher than that with LR (p < 0.001) but also was higher than the arterial concentration (p = 0.05). The renal tissue ketone body concentration was higher than in those with LR (p < 0.001) and also than in those without occlusion (p < 0.001).
Ketogenesis is enhanced in the kidney and may compensate for hepatic loss of ketogenic function during hepatic inflow occlusion under AR administration.
如我们之前的实验研究报道,主要在肝脏合成的酮体血水平,即使在肝血流阻断期间,如果给予醋酸林格液(AR),仍可维持,从而在再灌注期提高肝脏能量水平。本研究旨在证明,如果给予AR,肾脏是在肝血流阻断期间有助于合成酮体的器官。
在肝脏缺血20分钟和再灌注30分钟时,测定给予AR或乳酸林格液(LR)的家兔的动脉、中心静脉、肾静脉和肾组织中的酮体浓度。还比较了在AR输注下有或无20分钟肝脏缺血的家兔的浓度。采用方差分析进行统计分析。
给予AR时,肾静脉酮体浓度不仅高于给予LR时(p<0.001),而且高于动脉浓度(p = 0.05)。肾组织酮体浓度高于给予LR的家兔(p<0.001),也高于未阻断的家兔(p<0.001)。
在给予AR的情况下,肝血流阻断期间肾脏生酮作用增强,可能补偿肝脏生酮功能的丧失。