不同時相遠(yuǎn)端缺血預(yù)處理對腹腔鏡腎部分切除病人急性腎損傷的影響
發(fā)布時間：2018-09-08 13:49
【摘要】：目的腎臟由于其組織結(jié)構(gòu)和功能的特殊性,是對缺血再灌注損傷(Ischemia-reperfusion injury,IRI)敏感的器官之一。臨床上腎IRI比較多見。腎IRI是急性腎衰竭(acute kidney failure, AKF)的常見原因,也是腎臟移植術(shù)后影響移植物早期功能恢復(fù)和移植物長期存活的主要因素之一。因此,尋求新的治療策略來降低腎IRI程度是當(dāng)前臨床上密切關(guān)注的問題。本實驗旨在通過對病人肢體進(jìn)行間斷的缺血預(yù)處理,探討遠(yuǎn)端缺血預(yù)處理(remote ischemia preconditioning, RIPC)早期相保護(hù)(第一窗)和晚期相保護(hù)(第二窗)對腹腔鏡腎部分切除病人急性腎損傷的影響。 方法選擇60例腎腫瘤擇期行腹腔鏡下腎部分切除術(shù)的病人隨機(jī)分為3組：早期遠(yuǎn)端缺血預(yù)處理組(early RIPC,ERIPC組)、晚期遠(yuǎn)端缺血預(yù)處理組(late RIPC,LPdPC組)和對照組(CON組),每組20例。ERIPC組在麻醉誘導(dǎo)前在病人上肢綁骨科氣壓止血帶充氣到200mmHg持續(xù)5min,放氣5min,如此重復(fù)3個循環(huán)。LRIPC組于手術(shù)前24h在病人上肢綁骨科氣壓止血帶充氣到200mmHg持續(xù)5min,放氣5min,如此重復(fù)3個循環(huán)。CON組不做肢體遠(yuǎn)端缺血預(yù)處理。分別于麻醉誘導(dǎo)前(T0)、術(shù)后2h(T1)、6h(T2)抽取頸內(nèi)靜脈血檢測血清中性粒細(xì)胞明膠酶相關(guān)載脂蛋白(NGAL)和血清半胱氨酸蛋白酶抑制劑(胱抑素C, CysC)濃度來評估腎損傷。記錄病人術(shù)前和術(shù)后3個月通過99Tcm-二乙三胺五醋酸腎動態(tài)顯像(99Tcm-DTPA RDI)測定的單側(cè)腎小球濾過率(GFR)來評估腎功能。 結(jié)果三個組術(shù)前血清NGAL和CysC基礎(chǔ)濃度沒有明顯的統(tǒng)計學(xué)差異。與CON組比較,ERIPC組和LRIPC組病人的NGAL濃度和Cys C濃度在T1、T2均有一定程度的降低(P0.05)。同樣與CON組比較,兩實驗組病人術(shù)后3個月患側(cè)腎99Tcm-DTPA GFR百分比改變要小(P0.05)。ERIPC組與LRIPC組比較,后者的NGAL、CysC濃度降低更多,患側(cè)腎99Tcm-DTPA GFR百分比改變更輕微(P0.05)。 結(jié)論肢體遠(yuǎn)端缺血預(yù)處理無論早期相還是延遲相對腹腔鏡下腎部分切除病人腎缺血再灌注損傷均有一定程度的保護(hù)作用,而延遲相保護(hù)更明顯。
[Abstract]:Objective the kidney is one of the sensitive organs to ischemia reperfusion injury (Ischemia-reperfusion injury,IRI) because of its special structure and function. Renal IRI is more common in clinic. Renal IRI is a common cause of acute renal failure (acute kidney failure, AKF). It is also one of the main factors affecting the early functional recovery and long-term survival of grafts after renal transplantation. Therefore, to seek new treatment strategies to reduce the severity of renal IRI is currently the focus of clinical attention. The purpose of this study was to investigate the effects of early phase protection (first window) and late phase protection (second window) of distal ischemic preconditioning on acute renal injury in patients undergoing laparoscopic partial nephrectomy by intermittent ischemic preconditioning. Methods Sixty patients with renal tumors undergoing laparoscopic partial nephrectomy were randomly divided into three groups: early distal ischemic preconditioning group (early RIPC,ERIPC group), late distal ischemic preconditioning group (late RIPC,LPdPC group) and control group (CON group). In ERIPC group, the upper extremities were tied to orthopedic tourniquet and inflated to 200mmHg for 5 min and exhaled for 5 min before anesthesia induction, so repeated three cycles. LRIPC group inflated orthopedic tourniquet 24 hours before operation until 200mmHg lasted for 5 mins and exhaled for 5 mins. So repeated 3 cycles. Con group did not do distal limb ischemic preconditioning. The serum levels of neutrophil gelatinase-associated apolipoprotein (NGAL) and cysteine protease inhibitor (cystatin C, CysC) were measured before anesthesia induction (T 0) and 2 h (T 1) and 6 h (T 2) postoperatively to evaluate renal injury. Renal function was evaluated by unilateral glomerular filtration rate (GFR) measured by 99Tcm-diethylenetriamine pentaacetic acid renal dynamic imaging (99Tcm-DTPA RDI) before and 3 months after operation. Results there was no significant difference in serum NGAL and CysC levels between the three groups before operation. Compared with CON group, the concentration of NGAL and Cys C in ERIPC group and LRIPC group were decreased to some extent at T _ 1 and T _ 2 (P0.05). Compared with the CON group, the percentage of 99Tcm-DTPA GFR in the affected kidney in the two experimental groups was lower than that in the LRIPC group 3 months after operation (P0.05). Compared with the LRIPC group, the NGAL,CysC concentration in the latter group was lower than that in the LRIPC group, and the percentage of 99Tcm-DTPA GFR in the affected kidney was more slight (P0.05). Conclusion Ischemic preconditioning of distal extremity has a protective effect on renal ischemia-reperfusion injury in patients with partial nephrectomy under laparoscope in both early phase and delayed phase, and delayed phase protection is more obvious than that of Laparoscopic partial nephrectomy.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614
本文編號：2230703
[Abstract]:Objective the kidney is one of the sensitive organs to ischemia reperfusion injury (Ischemia-reperfusion injury,IRI) because of its special structure and function. Renal IRI is more common in clinic. Renal IRI is a common cause of acute renal failure (acute kidney failure, AKF). It is also one of the main factors affecting the early functional recovery and long-term survival of grafts after renal transplantation. Therefore, to seek new treatment strategies to reduce the severity of renal IRI is currently the focus of clinical attention. The purpose of this study was to investigate the effects of early phase protection (first window) and late phase protection (second window) of distal ischemic preconditioning on acute renal injury in patients undergoing laparoscopic partial nephrectomy by intermittent ischemic preconditioning. Methods Sixty patients with renal tumors undergoing laparoscopic partial nephrectomy were randomly divided into three groups: early distal ischemic preconditioning group (early RIPC,ERIPC group), late distal ischemic preconditioning group (late RIPC,LPdPC group) and control group (CON group). In ERIPC group, the upper extremities were tied to orthopedic tourniquet and inflated to 200mmHg for 5 min and exhaled for 5 min before anesthesia induction, so repeated three cycles. LRIPC group inflated orthopedic tourniquet 24 hours before operation until 200mmHg lasted for 5 mins and exhaled for 5 mins. So repeated 3 cycles. Con group did not do distal limb ischemic preconditioning. The serum levels of neutrophil gelatinase-associated apolipoprotein (NGAL) and cysteine protease inhibitor (cystatin C, CysC) were measured before anesthesia induction (T 0) and 2 h (T 1) and 6 h (T 2) postoperatively to evaluate renal injury. Renal function was evaluated by unilateral glomerular filtration rate (GFR) measured by 99Tcm-diethylenetriamine pentaacetic acid renal dynamic imaging (99Tcm-DTPA RDI) before and 3 months after operation. Results there was no significant difference in serum NGAL and CysC levels between the three groups before operation. Compared with CON group, the concentration of NGAL and Cys C in ERIPC group and LRIPC group were decreased to some extent at T _ 1 and T _ 2 (P0.05). Compared with the CON group, the percentage of 99Tcm-DTPA GFR in the affected kidney in the two experimental groups was lower than that in the LRIPC group 3 months after operation (P0.05). Compared with the LRIPC group, the NGAL,CysC concentration in the latter group was lower than that in the LRIPC group, and the percentage of 99Tcm-DTPA GFR in the affected kidney was more slight (P0.05). Conclusion Ischemic preconditioning of distal extremity has a protective effect on renal ischemia-reperfusion injury in patients with partial nephrectomy under laparoscope in both early phase and delayed phase, and delayed phase protection is more obvious than that of Laparoscopic partial nephrectomy.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614
【參考文獻(xiàn)】
相關(guān)期刊論文 前6條
1 張世卿,茍欣;腎缺血再灌注損傷細(xì)胞凋亡的分子生物學(xué)研究[J];國外醫(yī)學(xué).泌尿系統(tǒng)分冊;2005年02期
2 丁弘;劉殿閣;;不同類型熱休克蛋白在腎臟疾病中作用[J];臨床薈萃;2008年18期
3 林禮興;雷煥英;林麗婷;;血清中胱抑素C測定對評價腎小球濾過功能的重要價值[J];臨床和實驗醫(yī)學(xué)雜志;2006年07期
4 張鴻彥;孫玲娣;趙達(dá)亞;;慶大霉素誘導(dǎo)急性腎損傷大鼠腎臟熱休克蛋白70的表達(dá)[J];實用兒科臨床雜志;2007年05期
5 王宇萍;蔣建東;;熱休克蛋白70的結(jié)構(gòu)和功能[J];中國細(xì)胞生物學(xué)學(xué)報;2010年02期
6 李現(xiàn)軍,孫建梅,李廣宙,謝海,劉志翔,張磊;~(99)Tc~m-DTPA腎動態(tài)顯像對早期慢性腎功能衰竭的診斷價值[J];中華核醫(yī)學(xué)雜志;2005年01期
，本文編號：2230703
本文鏈接：http://sikaile.net/yixuelunwen/mazuiyixuelunwen/2230703.html
最近更新
教材專著
