Reperfusion injury: laboratory artifact or clinical dilemma?
Reperfusion injury: laboratory artifact or clinical dilemma?
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再灌注损伤：实验室伪影还是临床困境？
作者：
W. Nayler;J. S. Elz
在过去的几年里，为缺血心肌恢复充足血液供应的可能性大大增加，部分原因是有效的、无毒的溶栓剂的开发，部分原因是手术和血管成形术的改进。然而，这种干预措施在多大程度上是有益的，以及在什么时候是有益的，这是一个有争议的问题，因为在某些条件下，再灌注似乎危及潜在的可挽救的心肌。2赫斯和内勒及其同事在很大程度上要负责普及关于心脏的“再灌注损伤”的概念，在过去的十年中，这种现象的发生得到了广泛的研究，特别是在实验中，在长期常温的全球缺血后，分离的心脏被重新灌流。在这些条件下，在体外，量化任何与再灌注相关的额外损伤相对容易。细胞内酶和其他大分子的洗脱，2超微结构的大体变化，舒张期末期静息张力的持续增加，组织水和钙的增加，以及未能排除细胞外标志物和染料，只是已经使用的几个指标。4‘5相反，在活体条件下检测和量化与缺血后再灌注相关的损害相对困难，特别是当终点涉及测量梗塞面积时。必须考虑许多因素，包括存在侧支循环的数量，周围循环中伴随的血流动力学变化，甚至是梗塞的准确位置和大小。即使所有这些因素都得到了控制，
THE POSSIBILITY of restoring an adequate supply of blood to the ischemic myocardium has been considerably increased during the past few years, partly because of the development of potent, nontoxic thrombolytic agents' and in part because of improved surgical and angioplastic techniques. However, to what extent, and precisely when, such interventions are beneficial is a matter for debate, since under certain conditions reperfusion appears to jeopardize potentially salvageable myocardium.2 Hearse and Nayler and their colleagues` were largely responsible for popularizing the concept of "reperfusion injury" with respect to the heart and during the past decade the occurrence of this phenomenon has been widely investigated, particularly in experiments in which isolated hearts have been reperfused after prolonged periods of normothermic global ischemia. Under these conditions in vitro the quantification of any additional injury associated with reperfusion is relatively easy. The washout of intracellular enzymes and of other macromolecules,2 gross changes in ultrastructure, sustained increases in end-diastolic resting tension, increases in tissue water and calcium, and a failure to exclude extracellular markers and dyes are only a few of the indexes that have been used.4'5 By contrast, the detection and quantification of damage associated with postischemic reperfusion under conditions in vivo is relatively difficult, particularly if the end point involves the measurement of infarct size. Many factors have to be taken into account, including the amount of collateral flow that is present, accompanying hemodynamic changes in the peripheral circulation, and even the precise location and size of the infarct. Even if all of these factors are controlled an
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狗心脏体外完全缺血时溶血磷脂积累与质膜损伤的关系。
影响因子：
5
作者：
Steenbergen,C;Jennings,RB
通讯作者：
Jennings,RB
通过暂时改变再灌注液钙、钾、pH 值和渗透压来减少缺血后损伤。
DOI：
--
发表时间：
1981
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Follette,DM;Fey,K;Buckberg,GD;HellyJr,JJ;Steed,DL;Foglia,RP;MaloneyJr,JV
通讯作者：
MaloneyJr,JV
使用嘌呤从头合成的前体加速犬缺血后心肌中 ATP 和 GTP 库的补充。
影响因子：
20.1
作者：
Swain,JL;Hines,JJ;Sabina,RL;Holmes,EW
通讯作者：
Holmes,EW
缺血和缺氧对狗心脏肌膜的影响比较。
影响因子：
39.3
作者：
Jennings,RB;SteenbergenJr,C;Kinney,RB;Hill,ML;Reimer,KA
通讯作者：
Reimer,KA
参与挽救缺血心肌的因素：动脉血再灌注的影响。
影响因子：
37.8
作者：
Jennings,RB;Reimer,KA
通讯作者：
Reimer,KA