Remote ischaemic conditioning: cardiac protection from afar.
Remote ischaemic conditioning: cardiac protection from afar.
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DOI：
10.1111/anae.12973
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发表时间：
2015-06
期刊：
影响因子：
10.7
通讯作者：
Hausenloy DJ
中科院分区：
文献类型：
--
作者：
Sivaraman V;Pickard JM;Hausenloy DJ
对于缺血性心脏病患者，远程缺血预处理可以提供一种创新的、无创的、几乎无成本的治疗方法，用于保护心肌免受急性缺血再灌注损伤的不利影响，保护心脏功能并改善临床结局。远程缺血条件反射的有趣现象在20多年前首次被发现，当时显示心脏可以通过将一个或多个周期的短暂缺血和再灌注应用于远离心脏的器官或组织来抵抗急性缺血-再灌注损伤-最初称为“远距离心脏保护”。随后的临床前和临床研究发现，通过使用袖带诱导上肢或下肢短暂缺血和再灌注，可以非侵入性地引发远程缺血性条件反射。尽管涉及神经激素途径，但远程缺血预处理心脏保护的实际机制仍不清楚。自1993年首次发现以来，2006年进行了第一次远程缺血条件作用的概念验证临床研究，现在正在进行多中心临床结局研究。在这篇综述文章中，我们探讨了这种学术好奇心的潜在机制，并评估了其在临床应用中的成功。
For patients with ischaemic heart disease, remote ischaemic conditioning may offer an innovative, non‐invasive and virtually cost‐free therapy for protecting the myocardium against the detrimental effects of acute ischaemia‐reperfusion injury, preserving cardiac function and improving clinical outcomes. The intriguing phenomenon of remote ischaemic conditioning was first discovered over 20 years ago, when it was shown that the heart could be rendered resistant to acute ischaemia‐reperfusion injury by applying one or more cycles of brief ischaemia and reperfusion to an organ or tissue away from the heart – initially termed ‘cardioprotection at a distance’. Subsequent pre‐clinical and then clinical studies made the important discovery that remote ischaemic conditioning could be elicited non‐invasively, by inducing brief ischaemia and reperfusion to the upper or lower limb using a cuff. The actual mechanism underlying remote ischaemic conditioning cardioprotection remains unclear, although a neuro‐hormonal pathway has been implicated. Since its initial discovery in 1993, the first proof‐of‐concept clinical studies of remote ischaemic conditioning followed in 2006, and now multicentre clinical outcome studies are underway. In this review article, we explore the potential mechanisms underlying this academic curiosity, and assess the success of its application in the clinical setting.