Nifedipine can preserve renal function in patients undergoing aortic surgery with infrarenal crossclamping

被引:16
作者
Antonucci, F
Calo, L
Rizzolo, M
Cantaro, S
Bertolissi, M
Travaglini, M
Geatti, O
Borsatti, A
DAngelo, A
机构
[1] UNIV PADUA, DIV NEPHROL, INST INTERNAL MED, I-35128 PADUA, ITALY
[2] REG HOSP UDINE, DIV NEPHROL, UDINE, ITALY
[3] REG HOSP UDINE, DEPT ANESTHESIA 2, UDINE, ITALY
[4] REG HOSP UDINE, DIV SURG 3, UDINE, ITALY
[5] REG HOSP UDINE, DIV NUCL MED, UDINE, ITALY
来源
NEPHRON | 1996年 / 74卷 / 04期
关键词
aortic surgery; endothelin; nifedipine; prostaglandins; renal function;
D O I
10.1159/000189472
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Sixteen patients diagnosed with an aneurysm of abdominal aorta or Leriche disease underwent elective aortic surgery involving crossclamping of infrarenal aorta (ICC). These patients were randomized into two equal groups and 8 patients were infused with nifedipine starting from the isolation of aorta until the end of surgery (group A) while another 8 patients were infused with low-dose dopamine (group B) over the same surgical course. Plasma endothelin (ET) was measured before the induction of anesthesia, at the beginning and at the end of the clamp period and at the end of the operation. Intraoperatively, creatinine clearance and urinary excretion of PGE(2), 6-keto PGF(1 alpha) and TxB(2) were also determined before, during and after aortic crossclamping. Preoperative GFR as well as preinduction cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) of the two groups did not differ. During crossclamping plasma ET rose significantly in both groups. However, after clamp removal, plasma ET decreased in group A while it remained elevated in group B. Urinary excretion of TxB(2), PGE(2) and 6-keto PGF(1 alpha) increased during clamp in both groups, but the ratio of PGE(2) + 6-keto PGF(1 alpha)/TxB(2) during and after clamp was significantly higher in group A than in B. Postclamp creatinine clearance decreased in group B, and increased in group A; postoperative value of GFR was unchanged in group A and decreased significantly in group B. In conclusion, infusion of nifedipine, in contrast to dopamine, prevented the decrease of GFR in patients undergoing aortic surgery. This effect could be mediated by a nifedipine modulation of ET vascular synthesis and/or a preferential renal synthesis of vasodilating prostanoids.
引用
收藏
页码:668 / 673
页数:6
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