急性缺氧对肾功能的影响及克普定的利尿作用探讨

Effect of Acute Hypoxia on the Renal Function in the Pigs and the Change after Administration of Captopril

慢性阻塞性肺疾患病者极易发生急性缺氧,除引起肺动脉高压外亦可导致水代谢障碍,但此障碍可由多种原因引起如明显的右心功能不全,内分泌异常或缺氧直接对肾脏作用而引起。至今有关缺氧对肾小球、肾小管的作用的报道仍存在较多分歧,这是由于在整体实验中对肾功能的影响因素较多,在此我们将条件简化,观察单纯并伴有严格控制缺氧条件下猪的肾功能的变化规律及其与体循环血流动力学和有关介质的变化。此外,血管紧张素转换酶抑制剂对肾功能的影响已有报道,但在缺氧条件下能否仍起有效作用及其作用机理仍待深入了解,以探索能否作为肺心病合并心衰时的有效利尿药物。为此我们从1989年6月至9月进行了如下实验。

Experiments on acute hypoxia and administration of captopril,an angiotensin-converting enzyme inhibitor in 7 pigs under michanical venti- lation were made.The results showed that during hypoxemia both the glomerular filtration rate(GFR)and the urine flow rate(UFR)increas- ed,but no obvious change in excretion of electrocytes and hemodyna- mics.At the same time angiotensin-converting enzyme(ACE)decreased and angiotensin Ⅱ(ATII)increased.After the administration of capto- pril,GFR and UFR futher increased.The excretion of sodium and potas- sium increased remarkably.It is speculated that during hypoxia the de- crease of ACE resulted in the increase of badykinin which influenced the renal microcirculation so as to increase the GFR and UFR.But ATII influenced the renal tubulars through aldosterone.Captopril can improve the renal function even in the case of hypoxemia and may be helpful to treat the cot pulmonale with congestive heart failure.