The application of remote ischemic conditioning in cardiac surgery.
The application of remote ischemic conditioning in cardiac surgery.
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DOI：
10.12688/f1000research.11018.1
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Ge ZD
中科院分区：
文献类型：
--
作者：
Bosnjak ZJ;Ge ZD
围术期心肌缺血和心肌梗死是麻醉和手术后发病率和死亡率的主要原因。内源性心脏保护机制的发现导致了对保护人类心脏的新方法的测试。这些方法包括心肌的缺血预适应、预适应、后适应和远程适应。预适应和预适应分别包括在长时间缺血之前和期间的短暂和重复的亚致死性缺血；在再灌流开始时应用后处理。远程缺血条件是指在一个器官或组织(远离心脏)进行短暂、重复、非致命性的缺血和再灌注，使心肌对致命性缺血/再灌注损伤具有更强的抵抗力。在健康、年轻的心脏中，许多条件性动作可以显著增加心脏对缺血/再灌注损伤的抵抗力。到目前为止，大型多中心缺血远程调节临床试验在心脏手术中尚未被证明是成功的。临床上缺乏成功是由于干扰远程缺血调理的潜在危险因素，以及在远程缺血调理之前已经激活了内源性心脏保护机制的心脏保护剂的使用。未来使用远程缺血调节的临床前研究将需要使用共病模型进行。
Perioperative myocardial ischemia and infarction are the leading causes of morbidity and mortality following anesthesia and surgery. The discovery of endogenous cardioprotective mechanisms has led to testing of new methods to protect the human heart. These approaches have included ischemic pre-conditioning, per-conditioning, post-conditioning, and remote conditioning of the myocardium. Pre-conditioning and per-conditioning include brief and repetitive periods of sub-lethal ischemia before and during prolonged ischemia, respectively; and post-conditioning is applied at the onset of reperfusion. Remote ischemic conditioning involves transient, repetitive, non-lethal ischemia and reperfusion in one organ or tissue (remote from the heart) that renders myocardium more resistant to lethal ischemia/reperfusion injury. In healthy, young hearts, many conditioning maneuvers can significantly increase the resistance of the heart against ischemia/reperfusion injury. The large multicenter clinical trials with ischemic remote conditioning have not been proven successful in cardiac surgery thus far. The lack of clinical success is due to underlying risk factors that interfere with remote ischemic conditioning and the use of cardioprotective agents that have activated the endogenous cardioprotective mechanisms prior to remote ischemic conditioning. Future preclinical research using remote ischemic conditioning will need to be conducted using comorbid models.