Ali Ziad A, Callaghan Chris J, Lim Eric, Ali Ayyaz A, Nouraei S A Reza, Akthar Asim M, Boyle Jonathan R, Varty Kevin, Kharbanda Rajesh K, Dutka David P, Gaunt Michael E
Cambridge Cardiovascular Unit, Cambridge University Hospitals NHS Trust, Long Road, Cambridge, CB2 2QQ, UK.
Circulation. 2007 Sep 11;116(11 Suppl):I98-105. doi: 10.1161/circulationaha.106.679167.
Myocardial and renal injury commonly contribute to perioperative morbidity and mortality after abdominal aortic aneurysm repair. Remote ischemic preconditioning (RIPC) is a phenomenon whereby brief periods of ischemia followed by reperfusion in one organ provide systemic protection from prolonged ischemia. To investigate whether remote preconditioning reduces the incidence of myocardial and renal injury in patients undergoing elective open abdominal aortic aneurysm repair, we performed a randomized trial. METHOD AND RESULTS; Eighty-two patients were randomized to abdominal aortic aneurysm repair with RIPC or conventional abdominal aortic aneurysm repair (control). Two cycles of intermittent crossclamping of the common iliac artery with 10 minutes ischemia followed by 10 minutes reperfusion served as the RIPC stimulus. Myocardial injury was assessed by cardiac troponin I (>0.40 ng/mL), myocardial infarction by the American College of Cardiology/American Heart Association definition and renal injury by serum creatinine (>177 micromol/L) according to American Heart Association guidelines for risk stratification in major vascular surgery. The groups were well matched for baseline characteristics. RIPC reduced the incidence of myocardial injury by 27% (39% versus 12% [95% CI: 8.8% to 45%]; P=0.005), myocardial infarction by 22% (27% versus 5% [95% CI: 7.3% to 38%]; P=0.006), and renal impairment by 23% (30% versus 7%; [95% CI: 6.4 to 39]; P=0.009). Multivariable analysis revealed the protective effect of RIPC on myocardial injury (OR: 0.22, 95% CI: 0.07 to 0.67; P=0.008), myocardial infarction (OR: 0.18, 95% CI: 0.04 to 0.75; P=0.006) and renal impairment were independent of other covariables.
In patients undergoing elective open abdominal aortic aneurysm repair, RIPC reduces the incidence of postoperative myocardial injury, myocardial infarction, and renal impairment.
心肌和肾脏损伤通常是腹主动脉瘤修复术后围手术期发病和死亡的原因。远程缺血预处理（RIPC）是一种现象，即一个器官短暂缺血后再灌注，可为全身提供对长时间缺血的保护。为了研究远程预处理是否能降低择期开放性腹主动脉瘤修复患者心肌和肾脏损伤的发生率，我们进行了一项随机试验。
82例患者被随机分为接受RIPC的腹主动脉瘤修复组或传统腹主动脉瘤修复组（对照组）。以对双侧髂总动脉进行两个周期的间歇性夹闭为RIPC刺激，每次夹闭10分钟缺血后再灌注10分钟。根据美国心脏病学会/美国心脏协会对心肌梗死的定义，通过心肌肌钙蛋白I（>0.40 ng/mL）评估心肌损伤，根据美国心脏协会主要血管手术风险分层指南，通过血清肌酐（>177 μmol/L）评估肾脏损伤。两组在基线特征方面匹配良好。RIPC使心肌损伤发生率降低27%（39%对12%[95%CI：8.8%至45%]；P = 0.005），心肌梗死发生率降低22%（27%对5%[95%CI：7.3%至38%]；P = 0.006），肾功能损害发生率降低23%（30%对7%；[95%CI：6.4至39]；P = 0.009）。多变量分析显示，RIPC对心肌损伤（OR：0.22，95%CI：0.07至0.67；P = 0.008）、心肌梗死（OR：0.18，95%CI：0.04至0.75；P = 0.006）和肾功能损害的保护作用独立于其他协变量。
在接受择期开放性腹主动脉瘤修复的患者中，RIPC可降低术后心肌损伤、心肌梗死和肾功能损害的发生率。
