Andersson J, Eklöf B, Neglén P, Thomson D
Ann Surg. 1979 Mar;189(3):283-9. doi: 10.1097/00000658-197903000-00004.
The declamping shock has been attributed to reactive hyperemia with pooling of blood in the legs, metabolic acidosis following lactate accumulation in the ischemic leg muscles and hyperkalemia. We have studied eight patients undergoing arterial reconstruction with temporary aortic occlusion, in six cases because of obstructive arteriosclerotic disease and in two cases for aortic aneurysm. Muscle biopsies from the lateral vastus muscle as well as blood samples from the iliac vein, the superior caval vein and the radial artery were taken before clamping of the aorta, just before declamping, and 20 minutes after restitution of leg blood flow. ATP, ADP, AMP, phosphocreatine (PCr), creatine (Cr), glycogen, glucose, lactate, pyruvate and NH4+ from the immediately frozen muscle biopsies as well as lactate and pyruvate in the iliac vein and central venous blood were determined with an enzymatic, fluorometric technique. Only one patient reacted with a temporary hypotension at declamping. Arterial pH was unaffected during the operation, and no hyperkalemia was noted. During clamping of the aorta an increased lactate/pyruvate ratio in muscle indicated tissue hypoxia. Energy charge (EC) was, however, unchanged and the adenylate pool was maintained possibly due to a decrease in PCr. In spite of the restitution of blood flow after declamping of the aorta, no normalization of the metabolic state was seen, not even 20 minutes after the release of the clamp. EC was still unchanged but a significant decrease of both the adenylate and creatine pools was seen. These findings might indicate a damage of the mitochondria and the cellular membranes in skeletal muscle after temporary arterial occlusion.
松开阻断钳后的休克被认为与反应性充血、腿部血液淤积、缺血腿部肌肉中乳酸积累后的代谢性酸中毒以及高钾血症有关。我们研究了8例接受动脉重建并临时阻断主动脉的患者，其中6例因阻塞性动脉硬化疾病，2例因主动脉瘤。在主动脉阻断前、即将松开阻断钳时以及恢复腿部血流20分钟后，分别从股外侧肌取肌肉活检样本，并从髂静脉、上腔静脉和桡动脉采集血样。采用酶荧光技术测定即刻冷冻的肌肉活检样本中的三磷酸腺苷（ATP）、二磷酸腺苷（ADP）、一磷酸腺苷（AMP）、磷酸肌酸（PCr）、肌酸（Cr）、糖原、葡萄糖、乳酸、丙酮酸和铵离子（NH4+），以及髂静脉和中心静脉血中的乳酸和丙酮酸。只有1例患者在松开阻断钳时出现短暂性低血压。术中动脉pH值未受影响，未发现高钾血症。在主动脉阻断期间，肌肉中乳酸/丙酮酸比值升高表明组织缺氧。然而，能荷（EC）未变，腺苷酸库得以维持，这可能是由于PCr减少所致。尽管松开主动脉阻断钳后恢复了血流，但代谢状态并未恢复正常，即使在松开阻断钳20分钟后也未恢复正常。EC仍然未变，但腺苷酸和肌酸库均显著减少。这些发现可能表明临时动脉阻断后骨骼肌中的线粒体和细胞膜受到了损伤。
