Walsh Stewart R, Nouraei S A, Tang Tjun Y, Sadat Umar, Carpenter Roger H, Gaunt Michael E
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.
Vasc Endovascular Surg. 2010 Aug;44(6):434-9. doi: 10.1177/1538574410369709. Epub 2010 May 18.
Remote ischemic preconditioning (RIPC) is a physiological mechanism whereby brief ischemia-reperfusion episodes attenuate damage by subsequent prolonged ischemic insults. It reduces myocardial injury following cardiac and aortic aneurysm surgery. We aimed to determine whether RIPC affects neurological or cardiac injury following carotid endarterectomy (CEA). Patients were preconditioned using 10 minutes of lower limb ischemia-reperfusion. The primary neurological outcome was saccadic latency deterioration. The primary cardiac outcome measure was increased in serum troponin I >0.15 mg/dL. In all, 70 patients were randomized, of whom 55 completed the neurological surveillance protocol. Although there were fewer saccadic latency deteriorations in the RIPC arm, this did not reach statistical significance (32% versus 53%; P = .11). The primary cardiac outcome occurred in 1 patient in each arm (P = .97). There were no adverse events related to the preconditioning protocol. Remote ischemic preconditioning appears safe in patients with CEA. Large-scale trials are required to determine whether RIPC confers clinical benefits.
远程缺血预处理（RIPC）是一种生理机制，通过短暂的缺血再灌注发作减轻随后长时间缺血性损伤造成的损害。它可减少心脏和主动脉瘤手术后的心肌损伤。我们旨在确定RIPC是否会影响颈动脉内膜切除术（CEA）后的神经或心脏损伤。使用下肢缺血再灌注10分钟对患者进行预处理。主要神经学结果是扫视潜伏期恶化。主要心脏结局指标是血清肌钙蛋白I>0.15mg/dL升高。总共70例患者被随机分组，其中55例完成了神经学监测方案。尽管RIPC组扫视潜伏期恶化的情况较少，但未达到统计学显著性（32%对53%；P=0.11）。每组各有1例患者出现主要心脏结局（P=0.97）。没有与预处理方案相关的不良事件。远程缺血预处理在接受CEA的患者中似乎是安全的。需要进行大规模试验来确定RIPC是否具有临床益处。
