Therapeutic approaches for clinical ischemia and reperfusion injury
Therapeutic approaches for clinical ischemia and reperfusion injury
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DOI：
10.1097/00024382-199707000-00005
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发表时间：
1997-07-01
期刊：
影响因子：
3.1
通讯作者：
Cryer, HG
中科院分区：
文献类型：
--
作者：
Cryer, HG
最近的临床应用源于微循环和休克研究的策略，旨在预防缺血和再灌注综合征的后遗症，成功地降低了各种人类疾病的死亡率。最常用的原则仍然是早期再灌注，它已最成功地应用于球囊血管成形术治疗心肌梗死，并在最近使用纤溶药物治疗脑卒中中取得了中等成功。该策略旨在防止再灌注损伤发生，但适用性有限。临床上较为常用的治疗缺血再灌注综合征再灌注损伤成分的原则是控制再灌注，目前常规应用于移植，实验应用于外周动脉闭塞、脑卒中、心肌梗死的治疗。控制缺血微循环环境的策略已成功应用于移植和体外循环。这些技术最近在心脏手术、肢体缺血和移植的实验临床研究中进行了改良，以与控制再灌注相结合的方式使用。未来的策略有间接支持，但尚未在临床研究中进行测试，包括抗细胞因子治疗和缺血预处理。综上所述，实验动物治疗缺血再灌注损伤的成功已经慢慢融入到临床实践中。在心肌梗死、外周动脉闭塞、移植等方面取得了显著进展，但在中风、失血性休克等方面，我们还有很长的路要走。
Recent clinical applications of strategies derived from microcirculation and shock research directed at preventing the sequelae of ischemia and reperfusion syndromes are successfully decreasing mortality in a variety of human diseases. The most commonly applied principle remains early reperfusion, which has been most successfully applied in the treatment of myocardial infarction with balloon angioplasty and employed with moderate success in the recent treatment of stroke with fibrinolytic agents. This strategy is designed to prevent reperfusion injury before it occurs and has limited applicability. A more commonly used principle to clinically treat the reperfusion injury component of ischemia and reperfusion syndromes is controlled reperfusion, which is now routinely applied in transplant and experimentally applied in the treatment of peripheral artery occlusion, stroke, and myocardial infarction. Strategies to control the microcirculatory environment during ischemia are employed successfully in transplantation and cardiopulmonary bypass. These techniques have been recently modified for use in a combined fashion with controlled reperfusion in experimental clinical studies in heart surgery, limb ischemia, and transplantation, Future strategies that have indirect support but have not yet been tested in clinical studies include anticytokine therapy and ischemic preconditioning. In conclusion, the successes in the treatment of ischemia reperfusion injury in experimental animals have slowly been integrated into clinical practice. Marked gains have been made in the treatment of myocardial infarction, peripheral artery occlusion, and transplantation, On the other hand, in areas such as stroke and hemorrhagic shock, we have a long way to go.