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

骨骼肌再灌注损伤后发生的肌病代谢综合征(MNMS)是急性动脉闭塞症的严重而致命的并发症。为了避免和预测MNMS，在再灌流前对骨骼肌的缺血性损伤进行瞬时评估是必不可少的。1.11只麻醉犬双侧后肢在腹股沟处挤压造成缺血，分别在0h(I组，N=3)、1h(II组，N=3)、3h(III组，N=4)、6h(IV组，N=1)后进行再灌流。用LCR仪测量后肢骨骼肌电导率(G)。测定再灌流3小时(DELTA3G)后肢G的变化。方法：1.从缺血前至再灌流10h间歇性测定血清CPK和醛固酮酶(ALD)。…在AAA(3例)、ASO(1例)或急性动脉闭塞(1例)患者中，更多的患者测量了从动脉夹到灯泡的G值。术中和术后间歇性测定血清CPK，实验研究中缺血时G降低，再灌注后G升高。I、II组CPK、ALD无明显变化，III、IV组显著升高。DELTA3g在2.1mS/cm以下时，CPK和Ald在再灌流后无明显升高。但在DELTA3G超过2.1mS/cm的狗中，再灌注后它们显着增加。在DELTA3G>2.1mS/cm的犬，再灌注10h的肌酸磷酸酶和肌酸脱氢酶与DELTA3G有很好的相关性(P&lt；0.001)。在临床研究中，只有AAO患者的下肢G显著增加，且CPK高于其他患者。提示G的测定可以监测骨骼肌的缺血性损伤和再灌注期，可用于预测骨骼肌再灌注损伤。较少

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