心脏手术期间保护肥厚心脏的心脏停搏策略。
Cardioplegic strategies to protect the hypertrophic heart during cardiac surgery.
作者信息
Suleiman M-S, Hancock M, Shukla R, Rajakaruna C, Angelini G D
机构信息
Faculty of Medicine & Dentistry, Bristol Heart Institute, University of Bristol, Bristol, UK.
出版信息
Perfusion. 2011 Sep;26 Suppl 1(Suppl 1):48-56. doi: 10.1177/0267659111420607.
Abstract
Cardioplegic arrest and cardiopulmonary bypass are key triggers of myocardial injury during aortic valve surgery. Cardioplegic ischaemic arrest is associated with disruption to metabolic and ionic homeostasis in cardiomyocytes. These changes predispose the heart to reperfusion injury caused by elevated intracellular reactive oxygen species and calcium. Cardiopulmonary bypass is associated with an inflammatory response that can generate systemic oxidative stress which, in turn, provokes further damage to the heart. Techniques of myocardial protection are routinely applied to all hearts, irrespective of their pathology, although different cardiomypathies respond differently to ischaemia and reperfusion injury. In particular, the efficacy of cardioprotective interventions used to protect the hypertrophic heart in patients with aortic valve disease remains controversial. This review will describe key cellular changes in hypertrophy, response to ischaemia and reperfusion and cardioplegic arrest and highlight the importance of optimising cardioprotective strategies to suit hypertrophic hearts.
摘要
心脏停搏和体外循环是主动脉瓣手术期间心肌损伤的关键触发因素。心脏停搏缺血性停搏与心肌细胞代谢和离子稳态的破坏有关。这些变化使心脏易受细胞内活性氧和钙升高引起的再灌注损伤。体外循环与炎症反应相关，炎症反应可产生全身氧化应激，进而对心脏造成进一步损害。心肌保护技术常规应用于所有心脏，无论其病理情况如何，尽管不同的心肌病对缺血和再灌注损伤的反应不同。特别是，用于保护主动脉瓣疾病患者肥厚心脏的心脏保护干预措施的疗效仍存在争议。本综述将描述肥厚、对缺血和再灌注的反应以及心脏停搏中的关键细胞变化，并强调优化心脏保护策略以适应肥厚心脏的重要性。
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本文引用的文献
1
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J Heart Valve Dis. 2010 Nov;19(6):716-22.
2
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Future Cardiol. 2010 Nov;6(6):845-58. doi: 10.2217/fca.10.102.
3
Remote perconditioning reduces myocardial injury in adult valve replacement: a randomized controlled trial.远程预处理可减少成人瓣膜置换术中的心肌损伤：一项随机对照试验。
J Surg Res. 2010 Nov;164(1):e21-6. doi: 10.1016/j.jss.2010.06.016. Epub 2010 Jul 2.
4
Animal and human studies with the mitochondria-targeted antioxidant MitoQ.动物和人体研究使用靶向线粒体的抗氧化剂 MitoQ。
Ann N Y Acad Sci. 2010 Jul;1201:96-103. doi: 10.1111/j.1749-6632.2010.05627.x.
5
Induced remote ischemic pre-conditioning on ischemia-reperfusion injury in patients undergoing coronary artery bypass.诱导远程缺血预处理对冠状动脉搭桥术患者缺血再灌注损伤的影响
J Coll Physicians Surg Pak. 2010 Jul;20(7):427-31.
6
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Heart Fail Rev. 2011 Jan;16(1):49-69. doi: 10.1007/s10741-010-9180-8.
7
Modulation of myocardial metabolism: an emerging therapeutic principle.心肌代谢的调节：一种新兴的治疗原则。
Curr Opin Cardiol. 2010 Jul;25(4):329-34. doi: 10.1097/HCO.0b013e328339f191.
8
Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest.远程缺血预处理可减少晶体停搏冠状动脉旁路手术后的心肌损伤。
Basic Res Cardiol. 2010 Sep;105(5):657-64. doi: 10.1007/s00395-010-0104-5. Epub 2010 May 21.
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Eur J Cardiothorac Surg. 2010 Dec;38(6):745-9. doi: 10.1016/j.ejcts.2010.03.052. Epub 2010 May 7.
10
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J Card Surg. 2010 May;25(3):267-71. doi: 10.1111/j.1540-8191.2010.01000.x. Epub 2010 Feb 18.
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