Renal oxygenation, function and histopathology in an ovine model of heart failure undergoing cardiopulmonary bypass with 48 hours of recovery: a prospective, observational study*

IF 7.4 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia Pub Date : 2026-09-29 DOI:10.1111/anae.70425

Anton L. Trask‐Marino, Bruno Marino, Taku Furukawa, Lachlan F. Miles, Jai Raman, Andrew D. Cochrane, Peter R. McCall, Terase F. Lancefield, Roger G. Evans, Ian E. Birchall, Alemayehu H. Jufar, Ashenafi Betrie, Lars I.P. Snel, Munenori Kusunoki, Sally G. Hood, Linda Cornthwaite, Bruce Treagus, Connie Pei Chen Ow, Lindsea C. Booth, Clive N. May, Yugeesh R. Lankadeva

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引用次数: 0

Abstract

Summary Introduction Acute kidney injury is common after cardiac surgery requiring cardiopulmonary bypass, yet preventive strategies are limited. Progress has been hindered by a lack of clinically relevant experimental models incorporating pre‐existing heart disease. This study aimed to evaluate the impact of heart failure on renal oxygenation and histopathological injury during and after cardiopulmonary bypass in a large animal model. Methods Heart failure was induced in 10 sheep (study group) via progressive coronary artery ligation; 10 healthy sheep served as controls (control group). We measured renal blood flow, renal function and renal cortical and medullary oxygenation before and after induction of anaesthesia, during 2 h of cardiopulmonary bypass and for 48 h postoperatively. Kidneys were collected at 48 h for histopathology. Results Cardiopulmonary bypass reduced renal blood flow (55%) and medullary oxygen tension (50%) in both groups (both p < 0.001). During the 48‐h recovery period, medullary oxygen tension remained low in the study group but normalised in the control group (mean (SD) 11 (11) vs. 31 (10) mmHg at 48 h, p = 0.01). Urine output was lower in the study group than in the control group over the 48‐h recovery period (mean (SD) 0.90 (0.54) vs. 2.24 (1.84) ml.kg ‐1 .h ‐1 at 48 h, p = 0.03). Histopathologically, the study group had a higher incidence of neutrophil infiltration (89% vs. 30%, p = 0.04), although the incidence of acute tubular necrosis, fibrosis and tubular casts did not differ significantly between groups. Discussion In this ovine model of heart failure, cardiopulmonary bypass led to persistent renal medullary hypoxia, oliguria and increased renal inflammation. These findings suggest that impaired renal medullary oxygenation and inflammation may drive cardiac surgery‐associated acute kidney injury and represent a key target for renoprotective strategies.

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体外循环后48小时恢复心力衰竭羊模型的肾氧合、功能和组织病理学：一项前瞻性观察研究*

急性肾损伤是心脏手术后需要体外循环的常见情况，但预防策略有限。缺乏临床相关的实验模型纳入预先存在的心脏病，阻碍了进展。本研究旨在评估心力衰竭对体外循环期间和之后肾氧合和组织病理学损伤的影响。方法采用渐进式冠状动脉结扎术诱导心力衰竭10只羊（研究组）；10只健康绵羊作为对照组。我们在麻醉诱导前后、体外循环2小时及术后48小时测量肾血流量、肾功能、肾皮质和肾髓质氧合。48 h取肾进行组织病理学检查。结果两组体外循环均能降低肾血流量（55%）和髓质氧张力（50%）（p均< 0.001）。在48小时的恢复期，研究组的髓质氧张力保持在较低水平，但对照组的髓质氧张力恢复正常（48小时时平均（SD） 11（11）比31 (10)mmHg, p = 0.01）。在48小时的恢复期内，研究组的尿量低于对照组(平均（SD） 0.90 （0.54) vs. 2.24 (1.84) ml.kg‐1 .h‐1,p = 0.03）。组织病理学上，研究组中性粒细胞浸润发生率较高（89% vs. 30%, p = 0.04），但急性肾小管坏死、纤维化和肾小管铸型的发生率在两组间无显著差异。在这个心力衰竭的绵羊模型中，体外循环导致持续的肾髓质缺氧、少尿和肾脏炎症增加。这些发现表明，受损的肾髓质氧合和炎症可能导致心脏手术相关的急性肾损伤，并代表了肾保护策略的关键目标。

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来源期刊

Anaesthesia 医学-麻醉学

CiteScore

21.20

自引率

9.30%

发文量

300

审稿时长

6 months

期刊介绍： The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.