Gerczuk Paul Z, Kloner Robert A
Heart Institute, Good Samaritan Hospital, Los Angeles, CA, USA.
Hosp Pract (1995). 2011 Aug;39(3):35-43. doi: 10.3810/hp.2011.08.577.
The attempt to find treatments that will reduce myocardial cell death during periods of ischemia and subsequent reperfusion has spanned nearly 40 years. Although many therapies have shown promise in animal models, relatively few have been successful in clinical trials. Some of the most effective clinical therapies involve techniques designed to elicit the heart's own innate capacity to protect itself. The ability of the heart to render itself more resistant to ischemia/reperfusion injury was not appreciated until the description of ischemic preconditioning in 1986. Following the discovery that brief, nonlethal episodes of ischemia conditioned the heart to better tolerate a subsequent prolonged episode of ischemia, alternative ways of evoking this endogenous cardioprotection were described. Ischemic postconditioning and remote conditioning are potentially useful tools for protecting ischemic myocardium, and have been shown to be beneficial in small clinical trials. Several pharmacologic agents have the ability to mimic the effects of ischemic conditioning and can also reduce the amount of cell death during ischemia/reperfusion. This article provides the clinician with an overview of the different techniques of ischemic conditioning and how they can protect the myocardium from ischemia/reperfusion injury. Additionally, several pharmacologic agents that can protect the heart in a similar manner are discussed.
寻找能够减少心肌缺血期及随后再灌注期细胞死亡的治疗方法的尝试已经持续了近40年。尽管许多疗法在动物模型中显示出了前景，但在临床试验中取得成功的相对较少。一些最有效的临床疗法涉及旨在激发心脏自身固有保护能力的技术。直到1986年缺血预处理被描述出来，心脏使自身对缺血/再灌注损伤更具抵抗力的能力才被认识到。在发现短暂的、非致死性的缺血发作能使心脏更好地耐受随后延长的缺血发作之后，人们描述了引发这种内源性心脏保护的其他方法。缺血后处理和远程预处理是保护缺血心肌的潜在有用工具，并且已在小型临床试验中显示出益处。几种药物制剂有能力模拟缺血预处理的效果，也能减少缺血/再灌注期间的细胞死亡量。本文为临床医生概述了缺血预处理的不同技术以及它们如何保护心肌免受缺血/再灌注损伤。此外，还讨论了几种能以类似方式保护心脏的药物制剂。
