The experimental study for avoidance and prediction of Myonephropathic-metabollic syndrome (MNMS)

骨骼肌再灌注损伤后的肌肾代谢综合征（MNMS）是急性动脉闭塞性疾病的关键和致命并发症。为了避免和预测MNMS，在再灌注前对骨骼肌的缺血性损伤进行瞬时评估是必不可少的。我们通过测量骨骼肌的电特性来评估下肢的缺血损伤和再灌注损伤，并进行了实验和临床研究。11只麻醉犬在腹股沟区挤压双侧后肢使其缺血，并在不同的时间间隔后再灌注，分别为Oh（I组，N=3）、1h（II组，N=3）、3h（III组，N=4）、6h（IV组，N=1）。用LCR仪测定后肢骨骼肌电导率(G)。测定再灌注3 h时大鼠后肢G （DELTA3G）的变化。从缺血前至再灌注10h间歇测定血清CPK和醛化酶（Ald）。在AAA （N=3）、ASO（N=1）或急性动脉闭塞（N=1）患者中，从动脉钳夹到脱夹，测量下肢G。术中及术后间歇测定血清CPK。在实验研究中，G在缺血时降低，再灌注后升高。ⅰ、ⅱ组CPK、Ald无明显变化，ⅲ、ⅳ组CPK、Ald明显升高。在2.1mS/cm DELTA3G下，再灌注后CPK和Ald均未升高。但在DELTA3G浓度大于2.1mS/cm的犬中，它们在再灌注后显著增加。当DELTA3G大于2.1mS/cm时，再灌注后10 h CPK和Ald与DELTA3G有良好的相关性（P<0.001）。在临床研究中，只有AAO患者下肢G明显升高，且CPK高于其他患者。我们认为G的测定可以监测骨骼肌缺血损伤和再灌注期，并可用于骨骼肌再灌注损伤的预测。少

Myonephropathic-metabolic syndrome (MNMS) following after reperfusion injury in the skeletal muscle is critical and lethal complication in acute arterial occlusive disease. For avoidance and prediction of MNMS,instantaneous assesment of ischemic damage of the skeletal muscle before reperfusion is essential. We performed experimental and clinical studies with measurement of electrical character in the skeletal muscle to assess ischemic damage and reperfusion injury in lower limbs.1.In eleven anesthetized dogs, the bilateral hindlimbs were squeezed at the inguinal region to make ischemia and they were reperfused after various intervals, which were Oh(Group I,N=3), 1h(Group II,N=3), 3h(Group III,N=4), 6h(Group IV,N=1). Electrical conductivity(G) of the skeletal muscles in hindlimbs was measured with an LCR meter. Change of G in hindlims during 3 hours of reperfusion(DELTA3G) were measured. Serum CPK and aldlase (Ald) were measured intermittently from preischemia to 10 hours reperfusion.2. … More In patients with AAA (N=3), ASO(N=1), or acute arterial occlusion(n=1), G of lower extremities was measured from arterial clamp to declamp. Serum CPK was measured during surgical operation and postoperative period, intermittently.In Experimental study, G was decreased during ischemia, and increased after reperfusion. In group I and II,CPK and Ald showed no significant changes, but in group III and IV,they increased significantly. In dogs indicated under 2.1mS/cm of DELTA3G,CPK and Ald were not increased after reperfusion. but in dogs indicated with more than 2.1mS/cm of DELTA3G they increased significantly after reperfusion. CPK and Ald at 10 hours after reperfusion correlated well (P<0.001) to DELTA3G in dogs whose DELTA3G were more than 2.1mS/cm.In clinical study, only AAO patient showed significant increase of G in lower extremities and he showed higher CPK than the other patients.We suggested that measurement of G may provide monitoring of ischemic injury of the skeletal muscle and reperfused phase, and be applicable to prediction of the skeletal muscular reperfusion injury. Less