Willis L R, Evan A P, Connors B A, Reed G, Fineberg N S, Lingeman J A
Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis 46202-5120, USA.
J Urol. 1996 Oct;156(4):1502-6.
This study examined the acute time course of effects of extracorporeal shock wave lithotripsy (ESWL) on renal hemodynamics in anesthetized minipigs with and without pretreatment with verapamil.
We applied ESWL (2000 shocks, 24 kV, unmodified Dornier HM3), to the right kidneys of isoflurane-anesthetized female pigs. Urine flow and renal hemodynamics were monitored from each kidney via ureteral balloon catheters. Arterial blood pressure and bilateral urine flow, glomerular filtration rate (GFR, insulin clearance) and renal plasma flow (RPF, para-aminohippurate clearance) were monitored for 45 minutes before ESWL, and at 1, 4 and 24 hours after ESWL.
Treatment with ESWL consistently caused unilateral hematuria and subcapsular renal hematomas in the shocked kidneys and significantly reduced GFR and RPF in those kidneys at 1 and 4 hours after ESWL. Urine flow was reduced through 24 hours in the shocked kidneys. Renal plasma flow, but not GFR, was significantly reduced in the contralateral (unshocked) kidneys at 1 and 4 hours after ESWL to the other kidneys. Verapamil blunted the ESWL-induced reductions of urine flow, GFR and RPF in the shocked kidneys and eliminated the reduction of RPF in the unshocked kidneys.
These experiments demonstrate that ESWL to 1 kidney acutely impaired hemodynamics in both kidneys and that verapamil attenuated the response in the shocked kidneys and eliminated it in the contralateral unshocked kidneys.
本研究探讨了体外冲击波碎石术（ESWL）对麻醉状态下的小型猪肾脏血流动力学的急性影响过程，以及维拉帕米预处理对此的作用。
我们对异氟烷麻醉的雌性猪的右肾施加ESWL（2000次冲击，24 kV，未改良的多尼尔HM3）。通过输尿管球囊导管监测每个肾脏的尿流和肾脏血流动力学。在ESWL前45分钟以及ESWL后1、4和24小时监测动脉血压、双侧尿流、肾小球滤过率（GFR，胰岛素清除率）和肾血浆流量（RPF，对氨基马尿酸清除率）。
ESWL治疗持续导致受冲击肾脏出现单侧血尿和肾包膜下血肿，且在ESWL后1小时和4小时，这些肾脏的GFR和RPF显著降低。受冲击肾脏的尿流在24小时内均减少。在对另一侧肾脏进行ESWL后1小时和4小时，对侧（未受冲击）肾脏的肾血浆流量显著降低，但GFR未降低。维拉帕米减弱了ESWL引起的受冲击肾脏尿流、GFR和RPF的降低，并消除了未受冲击肾脏RPF的降低。
这些实验表明，对一侧肾脏进行ESWL会急性损害双侧肾脏的血流动力学，而维拉帕米可减轻受冲击肾脏的反应，并消除对侧未受冲击肾脏的反应。
