Weber Nina C, Schlack Wolfgang
Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Best Pract Res Clin Anaesthesiol. 2005 Sep;19(3):429-43. doi: 10.1016/j.bpa.2005.02.003.
The mechanisms by which ischaemia reperfusion injury can be influenced have been the subject of extensive research in the last decades. Early restoration of arterial blood flow and surgical measures to improve the ischaemic tolerance of the tissue are the main therapeutic options currently in clinical use. In experimental settings ischaemic preconditioning has been described as protecting the heart, but the practical relevance of interventions by ischaemic preconditioning is strongly limited to these experimental situations. However, ischaemia reperfusion of the heart routinely occurs in a variety of clinical situations, such as during transplantations, coronary artery bypass grafting or vascular surgery. Moreover, ischaemia reperfusion injury occurs without any surgical intervention as a transient myocardial ischaemia during a stressful anaesthetic induction. Besides ischaemic preconditioning, another form of preconditioning was discovered over 10 years ago: the anaesthetic-induced preconditioning. There is increasing evidence that anaesthetic agents can interact with the underlying pathomechanisms of ischaemia reperfusion injury and protect the myocardium by a preconditioning mechanism. Hence, the anaesthetist himself can substantially influence the critical situation of ischaemia reperfusion during the operation by choosing the right anaesthetic. A better understanding of the underlying mechanisms of anaesthetic-induced cardioprotection not only reflects an important increase in scientific knowledge but may also offer the new perspective of using different anaesthetics for targeted intraoperative myocardial protection. There are three time windows when a substance may interact with the ischaemia reperfusion injury process: (1) during ischaemia, (2) after ischaemia (i.e. during reperfusion), and (3) before ischaemia (preconditioning).
在过去几十年中，缺血再灌注损伤的影响机制一直是广泛研究的主题。动脉血流的早期恢复以及提高组织缺血耐受性的手术措施是目前临床使用的主要治疗选择。在实验环境中，缺血预处理已被描述为对心脏具有保护作用，但缺血预处理干预措施的实际相关性在很大程度上仅限于这些实验情况。然而，心脏缺血再灌注在各种临床情况下经常发生，例如在移植、冠状动脉搭桥术或血管手术期间。此外，在应激性麻醉诱导期间，作为短暂性心肌缺血，缺血再灌注损伤可在没有任何手术干预的情况下发生。除了缺血预处理外，另一种预处理形式在10多年前被发现：麻醉诱导预处理。越来越多的证据表明，麻醉剂可与缺血再灌注损伤的潜在病理机制相互作用，并通过预处理机制保护心肌。因此，麻醉医生通过选择合适的麻醉剂，可在很大程度上影响手术期间缺血再灌注的危急情况。更好地理解麻醉诱导心脏保护的潜在机制，不仅反映了科学知识的重要增长，还可能为使用不同麻醉剂进行靶向性术中心肌保护提供新的视角。一种物质可能与缺血再灌注损伤过程相互作用的有三个时间窗：（1）缺血期间，（2）缺血后（即再灌注期间），以及（3）缺血前（预处理）。
