術前輸液及び出血が術前・中・後の腎機能に及ぼす影響

抄録

Postoperative acute renal insufficiency is a serious complication which is challenging a surgeon to find its remedy. To find out measures to prevent this complication from occurring is a very important problem. As a step toward finding the solution of this problem, the author investigated the effect of preoperative intake of water and transfusion of water on preoperative, midoperative and postoperative renal function in infants, children, adults and aged people. These effects were studied by measuring osmotic pressures of serum, urine and free water, and clearance of osmotic pressure, urea and creatinine. Further, effects of bleeding were examined in clinical cases by the above parameters, and in dogs with rapid hemorrhagic shock, by the use of ¹³¹I-MAA for renal blood flow and its regional blood flow. The results of these studies are as follows:
1. In infants and children, when plenty of water was given them preoperatively, favorable effects on renal function was found to be produced preoperatively midoperatively and postoperatively. Further, judging from changes in urinary osmotic pressure it was thought that it is better to perform operation in the morning than in the afternoon.
2. In adults and aged people, preoperative transfusion of 10 ml/kg of Ringer's solution to which lactic acid was added was seen to produce a favorable effect on renal function preoperatively, and midoperatively. Perhaps because midoperative solution transfusion was used, and moreover, whenever bleeding of more than 500 ml occurred, a corresponding amount of blood transfusion was immediately given, the effect of midoperative bleeding on renal function was not clear and no unfavorable effect worthy of special mention was recognized.
3. In dogs with rapid hemorrhagic shock metablic acidosis was noted to develop, and both cardiac volume and average arterial pressure were reduced nearly by half. Whereas 19.7% of ¹³¹-MAA which had been infused was found distributed to the kidney before hemorrhage, only 0.66% of it was found there 60 minutes after hemorrhage. As regards changes in the regional blood flow of the kidney, quite unlike the flow before hemorrhage, the flow after hemorrhage was found to have shifted, now flowing from the medullarly substance toward the cortex.