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體外反搏治療有效增強腎排泄(利尿)功能

EECP is an Effective Procedure to Augment Renal Excretory Function in Patients with Cirrhosis

Source From 資料來源 : https://academic.oup.com/ndt/article/20/5/920/1852241?login=false

 

EECP is an Effective Procedure to Augment Renal Excretory Function in Patients with Cirrhosis

BACKGROUND:

Advanced liver cirrhosis is characterized by cardiovascular changes, such as low arterial blood pressure, peripheral vasodilation and renal vasoconstriction. As a consequence, renal hypoperfusion, impaired diuresis and natriuresis and eventual hepatorenal syndrome may ensue. Previous studies using head-out water immersion to increase central blood volume have demonstrated the functional nature of the renal abnormalities. Enhanced external counterpulsation (EECP) is a new non-invasive cardiac assist device to augment diastolic blood pressure by electrocardiogram-triggered diastolic inflation and deflation of cuffs wrapped around the lower extremities. We investigated whether EECP would improve renal dysfunction of liver cirrhosis.

METHODS:

Twelve healthy controls and 19 patients with liver cirrhosis were observed during 2 h of baseline followed by 2 h of EECP. The following parameters of renal and cardiovascular function were measured: renal plasma flow by para-aminohippurate clearance, glomerular filtration rate (GFR) by inulin clearance, urine flow rate, urinary excretion rates of sodium and chloride, mean arterial blood pressure (MAP), renal vascular resistance (RVR) and plasma concentrations of renin, atrial natriuretic peptide (ANP), endothelin-1, antidiuretic hormone, epinephrine and N-epinephrine.

RESULTS:

EECP was well tolerated by healthy controls and cirrhotic patients alike. EECP increased MAP (cirrhotic patients: from 74+/-18 to 88+/-20 mmHg, P<0.01; controls: from 89+/-8 to 94+/-5 mmHg, P = NS) and ANP (cirrhotic patients: from 23+/-18 to 30+/-20 ng/l, P<0.05; controls: from 11+/-4 to 16+/-5 ng/l, P<0.01). The plasma renin concentration decreased (cirrhotic patients: from 98+/-98 to 58+/-57 ng/l, P<0.01; controls: from 4.6+/-1.6 to 3.4+/-1.1 ng/l, P<0.01). This was associated with improvement of the urinary flow rate (cirrhotic patients: from 3.6+/-1.8 to 4.6+/-0.7 ml/min, P<0.05; controls: from 1.8+/-1.5 to 2.8+/-1.9 ml/min, P<0.05), as well as of the sodium and chloride excretion rates in both groups. However, in contrast to healthy controls, GFR and renal plasma flow in cirrhotic patients failed to rise significantly. Renal vascular resistance fell numerically in healthy controls (68+/-5 vs 55+/-4 mmHg . min/l; P = NS). In contrast, RVR showed a significant increase by approximately 20% in cirrhosis (67+/-4 vs 80+/-8 mmHg . min/l; P<0.05). Endothelin-1 levels fell in controls (0.38+/-0.42 vs 0.31+/-0.35; P<0.05), whereas they remained statistically unchanged in cirrhotic patients. Epinephrine, N-epinephrine and vasopressin were not altered by EECP in either group.

CONCLUSIONS:

EECP is an effective procedure to augment renal excretory function in healthy volunteers as well as in patients with cirrhosis. In healthy volunteers, GFR and renal plasma flow increased during EECP. In contrast, these parameters remained unchanged in the patients and their renal vascular resistance increased during EECP. Therefore, EECP improves diuresis, but does not influence the vasoconstrictive dysregulation of the kidneys in liver cirrhosis.

 

「增強體外反搏:增強肝硬化患者腎功能的新技術」

背景

晚期肝硬化的特點是心血管變化,如低動脈血壓、周圍血管擴張和腎血管收縮。因此,腎臟灌注不足、尿液和鈉 排泄 受損以及最終可能導致肝腎綜合征。先前研究使用的頭離水浸泡術,以提高中心血容量的方法已經證明了腎功能異常的功能性特點。體外反搏治療(EECP)是一種新的非侵入性心臟輔助裝置,通過心電圖觸發的下肢袖帶舒張和收縮來增加舒張期血壓。我們調查了EECP是否可以改善肝硬化的腎功能障礙。

方法

觀察了12名健康對照組和19名肝硬化患者,在2小時的基線觀察後進行了2小時的EECP。測量了腎臟和心血管功能的以下參數:清除氨基苯甲酸,以測試腎血漿流量、腎小球濾過率(GFR)通過腎素清除法測得、尿液流量、鈉和氯的尿 排泄 率、平均動脈血壓(Mean Arterial Pressure)、腎血管阻力(RVR)和腎素、心鈉肽(ANP)、內皮素-1、抗利尿激素、腎上腺素和N-腎上腺素的血漿濃度。

結果

健康對照組和肝硬化患者對EECP的耐受性良好。EECP增加了MAP(肝硬化患者:從74升高到88 mmHg;對照組:從89升高到94 mmHg)和ANP(肝硬化患者:從23升高到30 ng/l;對照組:從11升高到16 ng/l)。血漿腎素濃度降低(肝硬化患者:從98降低到58 ng/l;對照組:從4.6降低到3.4 ng/l)。這與尿液流量以及兩組中鈉和氯的 排泄 率的改善有關。然而,與健康對照組相比,肝硬化患者的GFR和腎血漿流量未顯著升高。肝硬化患者的腎血管阻力顯著增加約20,而健康對照組的RVR數值上降低。內皮素-1水平在對照組降低,而在肝硬化患者中保持統計學上不變。EECP並不改變肝硬化患者和健康對照組的腎上腺素、N-腎上腺素和抗利尿激素。

結論

EECP是一種有效的方法,可以增加健康志願者和肝硬化患者的腎 排泄 功能。在健康志願者中,EECP能夠增加GFR和腎血漿流量。相比之下,在肝硬化患者中,這些參數保持不變,而且在EECP過程中腎血管阻力增加。因此,EECP改善了利尿功能,但對肝硬化的腎血管收縮調節沒有影響。

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