对比超声评价卡托普利对急性心功不全肾血流影响的实验研究

Effects of captopri on renal circulation in dogs with acute cardiac insufficiency by contrast-enhanced ultrasound

目的用对比超声方法定量分析卡托普利(CPT)引起的犬急性心功能不全的肾脏血流、微循环变化。方法13条杂种犬,左肋下开腹,在肾动脉主干上安置多普勒血流仪探头测单侧肾血流量(RBF)。在心输出量(CO)降至50%后,将卡托普利注射剂以1mg/kg静注,1h后以2mg/kg重复注射。分别于注射CPT前及1h后记录CO、RBF、mPCWP、mRAP、MAP、SVR。分别于注射CPT前及1h后行肾脏对比超声(CEUS)检查,测定肾微血管血流速度(β)、微血管容积(A)和微血管血流量(A×β)。结果急性心功能不全实验犬注射CPT后,CO、RBF、SaO2显著增加,MAP、SVR、mPWCP、mRAP显著下降。急性心功能不全实验犬注射CPT后肾血流量增加比值显著地大于心输出量增加比值。急性心功不全实验犬注射CPT后肾皮质微循环的血管容积(A)、血流速度β、及血流量(A×β)明显增加,肾髓质微循环的血管容积(A)无明显增加而血流速度β及血流量(A×β)明显增加。结论卡托普利对急性心功能不全的肾灌注非常有益。

Objective To assess the effect of captopril （CPT） on kidney microcirculation in dogs with acute cardiac insufficiency （ACI）. Methods Studies were performed in thirteen mongrel dogs. An ultrasonic flow probe was entered through exposing the left subcostal space and placed on the main renal artery to monitor instantaneous changes in renal blood flow （RBF）. Captopril （CPT） was injected at the dose of 1 mg/kg at 15 min after cardiac output （CO） decreased to 50% of the base. 1 h later, 2 mg/kg CPT was adminstrated. Contrast-enhanced ultrasound （CEUS） of the kidney was performed before and 1 h after the adminstration of CPT, and microvascular flow velocity（β） , microvascular volume （A） and microvascular blood flow were observed. CO, RBF, mean arterial pressure （MAP）, arterial oxygen saturation （SaO2）, mean right atrial pressure （mRAP）, mean pulmonary capillary wedge pressure （mPCWP）, systemic vascular resistance （SVR） were recorded at the same time. Results CO, RBF, SaO2 increased while mRAP, mPCWP, SVR decreased significantly following the adminstration of CPT. The improvement of RBF was more remarkable than that of CO. CPT adminstration produced a increase in all of the values of A, β, A×β in the renal cortex （CX） and the values of β, A×β in the medulla while no changes in the A value in the medulla. CO, RBF, SaO2 increased while mRAP, mPCWP, SVR decreased significantly following the adminstration of CPT. Conclusion CPT is very beneficial to renal circulation in dogs with ACI.