血管弹性对低温机械灌注时肾血管阻力的影响

Effect of vascular elasticity on renal vascular resistance during hypothermic machine perfusion

目的观察低温机械灌注(HMP)时肾血管阻力(RR)的影响因素及血管弹性对其的影响。方法对2020年期间脑心双死亡供体(DBCD)中1例左肾肾小球和肾血管通畅,右肾血管阻塞;及另一例肾小球硬化的3例废弃肾脏进行机械灌注并检测其血管阻力,同时建立兔肾间质纤维化(RIF)和急性肾功能衰竭(ARF)模型,获取肾脏后进行机械灌注,观察灌注前各组的组织形态及记录灌注后血清肌酐值、RR和流量值的改变并探讨肾血管阻力的影响因素。采用t检验进行组间的比较。结果废弃的3个肾脏在低温机械灌注12 h后,血管通畅和肾小球硬化的肾血管阻力明显低于血管阻塞的废肾[0.25 mmHg/(ml·min)比0.80 mmHg/(ml·min),0.40 mmHg/(ml·min)比0.80 mmHg/(ml·min)]。在动物模型中,出现肾间质纤维化和急性肾衰竭的兔肾血管阻力显著低于添加去甲肾上腺素的兔肾[(1.830±0.020)mmHg/(ml·min)比(2.000±0.010)mmHg/(ml·min),(1.830±0.020)mmHg/(ml·min)比(2.000±0.010)mmHg/(ml·min),t=13.17、13.17,P<0.05]。结论良好的血管弹性可以减轻低温机械灌注时的肾血管阻力。

Objective To explore the influencing factors of renovascular resistance(RR)during hypothermic machine perfusion(HMP),and to clarify the influence of vessel elasticity on renovascular resistance.Methods HMP was performed on discarded kidneys in the case of the left renal glomerulus and renal vascular patency,right renal vascular obstruction and another example of renal glomerular sclerosis,which were derived from donation after brain plus cardiac death(DBCD)in 2020.Then RR was detected.Besides,rabbit renal interstitial fibrosis(RIF)and acute renal failure(ARF)models were established.The obtained kidneys were perfused,the tissue morphology of each group before perfusion and the changes of serum creatinine value,RR and flow value after perfusion were recorded,and the influencing factors of RR were discussed.Continuous variables were expressed as means±standard.T-test was used for comparison between groups.Results After 12 h of perfusion in three discarded kidneys,RR in the kidney with vascular patency and glomerulosclerosis was significantly lower than that in the kidney with the blocked vessels[0.25 mmHg/(ml·min)vs.0.80 mmHg/(ml·min),0.40 mmHg/(ml·min)vs.0.80 mmHg/(ml·min)].In animal models,the RR of kidneys with interstitial fibrosis and acute renal failure was significantly lower than that in rabbits with norepinephrine[(1.830±0.020)mmHg/(ml·min)vs.(2.000±0.010)mmHg/(ml·min),(1.830±0.020)mmHg/(ml·min)vs.(2.000±0.010)mmHg/(ml·min),t=13.17,13.17,P<0.05].Conclusion Good vascular elasticity can reduce RR during HMP.