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目的 :拟通过建立肾脏缺血/再灌注模型探讨CRS的肾保护措施从而指导心肾等重要靶器官的临床保护。方法:52只急性心肌梗死(AMI)再灌注存活的猪入组,根据后续处理的不同随机分为以下4组:即室温复苏组、室温复苏同时灌注500 m L常温生理盐水组、室温复苏同时灌注500 m L 4℃生理盐水组和假手术组。各组同时观察了发生室性心律失常后1、3、5和10 min开放血流再灌注复苏后急性肾损伤(AKI)的相关指标的变化。收集血液及随机尿液标本进行相关的测定。结果:猪AMI缺血再灌注模型出现肾小管损伤标记物中性粒细胞明胶酶相关脂质运载蛋白(NGAL),L型脂肪酸结合蛋白(L-FABP),白介素18(IL-18)的升高,提示了亚临床AKI的发生,且肾损伤在血流动力学不稳定后迅速发生,而不同于以往文献中报道血流动力学不稳定后数小时出现AKI。在不同的干预措施下提示肾损伤的升高的生物学标志物有不同程度的下降,但其对远期预后的影响有待进一步研究探讨。结论:提示反映肾小管损伤标志物的升高可先于肾小球功能的改变,为I型CRS进行及时有效肾脏保护措施比如低温再灌注复苏争取宝贵的时机。
OBJECTIVE: To explore the renal protection measures of CRS by establishing renal ischemia / reperfusion model to guide the clinical protection of important target organs such as heart and kidney. Methods: Fifty-two AMI-reperfusion-alive pigs were randomly divided into four groups according to the follow-up treatment: RT-RT group, RT-500R saline infusion group, Perfused 500 m L 4 ℃ saline group and sham operation group. Each group also observed the change of related indexes of acute renal injury (AKI) after open perfusion resuscitation at 1, 3, 5 and 10 minutes after ventricular arrhythmia. Blood and random urine samples were collected and correlated. Results: The expression of neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty acid-binding protein (L-FABP) and interleukin 18 (IL-18) High, suggesting the occurrence of subclinical AKI, and renal injury occurs rapidly after hemodynamic instability, unlike the AKI that has been reported in the literature several hours after hemodynamic instability. Under different interventions, there are different degrees of decline of biomarkers suggesting that renal injury is elevated, but its impact on long-term prognosis remains to be further explored. CONCLUSIONS: The prompts indicate that elevated tubular markers of glomeruli may precede glomerular function changes and may be a valuable time for prompt and effective renal protection measures such as hypothermic reperfusion resuscitation of Type I CRS.