远端缺血预处理对同种异体肾移植术后患者肾功能的影响

目的:探讨远端缺血预处理对同种异体肾移植术后患者肾功能的影响。方法:选择行同种异体肾移植手术的患者20例,并将其随机分为实验组(S)和对照组(D),每组10例。S组于麻醉后在左下肢绑扎止血带行远端缺血预处理,D组不作缺血预处理。分别于术前(T0)、术后24(T1)、48(T2)、72h(T3)记录患者的尿量;生化检测患者血清尿素氮(BUN)和肌酐(Scr)含量;ELISA检测患者肾损伤分子-1(Kim-1)的含量。结果:两组患者的一般情况比较无统计学差异(P0.05)。两组患者术后各时点的尿量均较术前显著增加,且S组术后各时点的尿量均明显多于D组增多(P0.05)。两组患者术后各时点的Scr、BUN含量均较术前下降,两组T1、T2时点的Scr、BUN含量比较差异无统计学意义(P0.05),但S组术后T3时点血清Scr、BUN水平均明显低于D组(P0.05)。两组患者术后尿液Kim-1水平均较术前明显下降,S组在T3时点的Kim-1水平显著低于D组(P0.05)。结论:远端缺血预处理可显著减轻移植肾缺血再灌注损伤,有利于同种异体肾移植患者术后肾功能的恢复。

Effect of Remote Ischaemic Preconditioning on Renal Function in PatientsUndergoing Allograft Donor Kidney Transplantation

Objective:To investigate the effect of remote ischaemic preconditioning on renal function in patients undergoingallograft donor kidney transplantation.Methods:Twenty patients undergoing allograft donor kidney transplantation were randomlyassigned to remote ischaemic preconditioning (S) group (n=10) and control (D) group (n=10). After anesthesia, remote ischemicpreconditioning was induced by left lower extremity ischemia using a tourniquet inflated in the S group. Patients in the D groupunderwent sham placement of the tourniquet wrapped around the left lower extremity without inflation. 24 h urine volume, blood ureanitrogen (BUN), serum creatinine (Scr) and kidney injury molecule-1(Kim-1) were detected by ELISA before operation (T0) and at 24(T1), 48(T2) and 72h(T3) after operation.Results:No significant difference was observed in the baseline information between two groups(P>0.05). After surgery, the urine volume at all time points of patients from both groups were significantly increased than those beforeoperation (P<0.05), which was significantly more in the group S at all time points than those in the groupD (P<0.05); the BUN, Scr andKim-1 at all time points of patients from both groups were significantly decreased than before operation (P<0.05). No significantdifference was found in the BUN, Scr levels at T1 and T2 between two groups, but the serum BUN, Scr levels at T3 of group S weresignificantly lower than those of group D (P<0.05). The urine Kim levels of both groups were significantly lower than those beforeoperation, which at T3 of group S was significantly lower than that of groupD (P<0.05).Conclusion:Remote ischaemic preconditioningcould improve renal function through protecting the kidney against ischemia reperfusion injury in patients undergoing allograft donorkidney transplantation.