Eklöf B, Neglén P, Thomson D
Ann Surg. 1981 Jan;193(1):99-104. doi: 10.1097/00000658-198101000-00016.
Temporary infrarenal clamping of the aorta during reconstructive surgery induces incomplete ischemia of the leg muscle. After release of the clamp, severe muscle metabolic derangement with loss of high-energy phosphate compounds has been observed, indicating a dysfunction or damage of the muscle cells. In six patients operated on for occlusive aortoiliac disease, low-molecular-weight dextran (LMWD) was peroperatively administered for optimal volume loading and prevention of clotting. No heparin was used. Before, during and after the clamping period the central hemodynamics were monitored, and glycogen, glucose, lactate, pyruvate, phosphocreatine (PCr), creatine (Cr), ATP, ADP and AMP content in the thigh muscle were analyzed using enzymatic fluorometric techniques. Even though ischemia developed during the occlusion, no decline in the adenylate (ATP + ADP + AMP) or creatine (PCr + Cr) pools occurred after the clamp was released, and the energy charge of the adenine nucleotides remained unchanged. It is suggested that LMDX prevents rheologic changes impairing the microcirculation during and after the ischemic period, and thereby improves oxygenation of the muscle tissue upon reperfusion.
重建手术期间对主动脉进行暂时性肾下钳夹会导致腿部肌肉不完全缺血。钳夹松开后，已观察到严重的肌肉代谢紊乱以及高能磷酸化合物的损失，这表明肌肉细胞存在功能障碍或损伤。在6例接受闭塞性主-髂动脉疾病手术的患者中，术中给予低分子量右旋糖酐（LMWD）以实现最佳容量负荷并预防凝血。未使用肝素。在钳夹期之前、期间和之后监测中心血流动力学，并使用酶荧光技术分析大腿肌肉中的糖原、葡萄糖、乳酸、丙酮酸、磷酸肌酸（PCr）、肌酸（Cr）、ATP、ADP和AMP含量。尽管在闭塞期间出现了缺血，但钳夹松开后腺苷酸（ATP + ADP + AMP）或肌酸（PCr + Cr）池并未减少，腺嘌呤核苷酸的能荷保持不变。提示LMDX可防止缺血期及缺血后损害微循环的流变学变化，从而改善再灌注时肌肉组织的氧合。
