Dual exposure to sevoflurane improves anesthetic preconditioning in intact hearts.
Dual exposure to sevoflurane improves anesthetic preconditioning in intact hearts.
复制标题
双重暴露于七氟醚可改善完整心脏的麻醉预处理。
DOI：
10.1097/00000542-200403000-00016
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发表时间：
2004
期刊：
影响因子：
8.8
通讯作者：
Stowe,DavidF
中科院分区：
文献类型：
--
作者：
Riess,MatthiasL;Kevin,LeoG;Camara,AmadouKS;Heisner,JamesS;Stowe,DavidF
背景：七氟醚麻醉预处理（APC）可减少心肌缺血再灌注损伤。作者测试了两次短暂接触七氟醚是否会比一次长时间接触七氟醚产生更好的预处理状态，以及两次暴露于较低(L)浓度的七氟醚是否会达到与单次暴露于较高(H)浓度的结果相似的结果。方法：将langendorff制备的豚鼠心脏分别以0.4 mM七氟醚（H1-15; n 8）或0.4 mM （H2-5; n 8）或0.2 mM七氟醚（L2-5; n 8）两次暴露，持续15 min，穿插5 min洗脱期。然后冲洗七氟醚20分钟，然后进行30分钟的全无血流缺血和120分钟的再灌注。对照心脏（n 8）不进行APC。等容量测量左室压。采用四氮唑染色和累积平面法测定心室梗死面积。数值以平均SD表示。结果：与H1-15组（36.8%，P< 0.05）、L2-5组（43.6%，P< 0.05）、对照组（52.7%，P< 0.05）相比，H2-5组心肌功能恢复较好，心肌梗死再灌注率（28.9%）较低。结论：APC不仅与浓度有关，还与预处理方案有关。与缺血预处理类似，反复应用挥发性麻醉剂似乎比暴露时间更重要，以启动信号序列，引发临床相关浓度的APC。因此，在临床环境中，反复的麻醉暴露周期之后是挥发性无麻醉期可能对APC有益。
Background: Anesthetic preconditioning (APC) with sevoflu-rane reduces myocardial ischemia–reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevoflurane would achieve an outcome similar to that associated with a single exposure to a higher (H) concentration.Methods: Langendorff-prepared guinea pig hearts were ex-posed to 0.4 mM sevoflurane once for 15 min (H1-15; n 8) or 0.4 mM (H2-5; n 8) or 0.2 mM sevoflurane (L2-5; n 8) twice for 5 min, with a 5-min washout period interspersed. Sevoflurane was then washed out for 20 min before 30 min of global no-flow ischemia and 120 min of reperfusion. Control hearts (n 8) were not subjected to APC. Left ventricular pressure was measured isovolumetrically. Ventricular infarct size was determined by tetrazolium staining and cumulative planimetry. Values are expressed as mean SD.Results: The authors found a better functional return and a lesser percentage of infarction on reperfusion in H2-5 (28 9%) than in H1-15 (36 8%; P< 0.05), L2-5 (43 6%; P< 0.05), or control hearts (52 7%; P< 0.05).Conclusion: These results suggest that APC depends not only on the concentration but also on the protocol used for preconditioning. Similarly to ischemic preconditioning, repeated application of the volatile anesthetic seems to be more important than the duration of exposure in initiating the signaling sequence that elicits APC at clinically relevant concentrations. Therefore, repeated cycles of anesthetic exposure followed by volatile anesthetic–free periods may be beneficial for APC in the clinical setting.