Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2011 Jul;142(1):148-54. doi: 10.1016/j.jtcvs.2010.11.018. Epub 2011 Jan 26.
Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery.
Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters.
There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group.
In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.
体外循环心脏手术后发生急性肾损伤与全身炎症反应和氧化应激密切相关。远程缺血预处理是一种全身保护策略，通过短暂的肢体缺血对远处器官的长时间缺血和炎症反应提供全身保护。本研究旨在探讨远程缺血预处理是否对复杂心脏瓣膜手术中未直接暴露于缺血再灌注损伤的肾脏提供全身保护作用。
76 例接受复杂心脏瓣膜手术的成年患者被随机分为远程缺血预处理组（n = 38）和对照组（n = 38）。远程缺血预处理包括 3 个 10 分钟的下肢缺血-再灌注循环，使用自动充气袖带。主要终点是比较包括血清肌酐、胱抑素 C 和中性粒细胞明胶酶相关脂质运载蛋白在内的肾损伤生物标志物，以及急性肾损伤的发生率。次要终点是比较心肌酶释放和肺参数。
在整个研究期间，两组患者的肾损伤生物标志物血清水平均无显著差异。两组急性肾损伤的发生率无差异。与对照组相比，远程缺血预处理组术后 24 小时肌酸激酶同工酶 MB 较低，重症监护病房停留时间较短。
在接受复杂心脏瓣膜手术的患者中，远程缺血预处理并未减轻肾损伤程度或急性肾损伤的发生率，反而减轻了心肌损伤和重症监护病房停留时间。
