RESUMO
The pneumoperitoneum may reduce the renal blood flow which was demonstrated both in experimental and clinical research. Greater change could be seen as the pressure of pneumoperitoneum increased,which may induce lower GFR, decrease urine output ,increase the level of plasma Scr?BUN and so on.All these changes were related to the variety of hemodynamics?nerval-endocrine factors releasing?body position and sorts of insufflated gas.Ischemia-reperfusion injury also is an ignorable factor. Pneumoperitoneum may influence the kidney function , which is reversible under certain pressure and operating time,and were concerned with multiple mechanism. More obvious damage to the dysfunctional kidney could occur under high pressure of pneumoperitoneum.
RESUMO
Objective To study the protective effects of taurine on liver and kidney injury induced by intestinal ischemia-reperfusion(I/R) in rats.Methods Male Wistar rats were randomly assigned into Sham,I/R,and taurine groups.Thirty min before operation,2% taurine(200 mg/kg) was injected via dorsal vein of the rat′s penis.Intestinal ischemia-reperfusion was produced by occlusion of superior mesenteric artery for one hour later,then the blood flow was restored by removing the clamps.Blood samples were taken from rats in I/R and taurine groups at 1.5,3,6 and 12h after reperfusion,and the serum levels of ALT,AST,BUN and Cr were measured to evaluate the functions of liver and kidney.Tissues from livers and kidneys were cryostated and stained with hematoxylin and eosin to observe changes in histological pathology.TUNEL was also performed to examine apoptotic cells and the average light density levels were measured.Results The serum levels of ALT,AST,BUN and Cr in I/R group were significantly higher than those in Sham group(P
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Objective To explore the influence of increased intraabdominal pressure caused by ascites on renal function.Methods (1)The renal function , intraabdomanal pressure and renal artery resistence index before and after the operation were compared in 6 patients with refractory ascites treated by peritonovenous shunts. (2)The changes of renal arterial resistence , outflow of renal vein , cardiac output ,serum angiotensin and aldosterone were determined and compared under the condition of compression and decompression of abdominal cavity with raised intraabdominal pressure in 6 dog models. Results In 6 patients,asites disappeared after the shunts operation, intraabdominal pressure decreased from (25.2?6.6)cmH 2O to (6.4?3.0)cmH 2O,BUN decresed from (12.5?3.6)mmol/L to (8.2?2.6)mmol/L,renal arterial resistence decreased obviously.In the dog models,the cardiac output , adosterone and angiotension were no sigmificant differece in all the time,but renal arterial restence increased and venous outflow decreased significantly.However all the changes restored to normal levels after decompressions. Conclusion Elevated intraabdominal pressure by ascites can decreases renal blood perfusion and its function. peritonovenous shunt can decrease intraabdominal pressure effectively and improve renal function.
RESUMO
Objective To investigate the renal hemodynamic changes after orthotopic liver transplantation(OLT)and the correlative parameters. Methods In 20 patients undergoing OLT for cirrhosis,the following renal arterial resistance index(RI) was measured before surgery and 7days,30days, 6 months and 1 year after operation by using color Doppler flow imaging(CDFI) and serum creatinine detection.Meanwhile the same parameters were measured in 10 healthy as controls. Results Both RI and serum Cr rised after OLT ( P 0.05). Conclusions Most alteration of renal hemodynamic parameters in cirrhosis are restored to normal after OLT in 1 year. Preoperative renal abnormalities and intraopterative alteration of hemodynamic may contribute to postoperative renal dysfunction. Cyclosporine (CsA) is the most likely etiologic agent of postoperative renal dysfunction.
