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远程缺血预处理对接受冠状动脉旁路移植术的患者心脏并无保护作用。

Remote ischaemic preconditioning does not protect the heart in patients undergoing coronary artery bypass grafting.

作者信息

Lomivorotov Vladimir V, Shmyrev Vladimir A, Nepomnyaschih Valeriy A, Ponomarev Dmitriy N, Knyazkova Lubov G, Lomivorotov Vladimir N, Karaskov Alexandr M

机构信息

Department of Anesthesiology and Intensive Care, Academician E.N. Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia.

出版信息

Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):18-22. doi: 10.1093/icvts/ivs118. Epub 2012 Apr 4.

Abstract

Remote ischaemic preconditioning (RIPC) gained attention as a possibility to reduce myocardial injury after a subsequent sustained episode of myocardial ischaemia. This prospective randomized study was carried out to assess whether RIPC reduces myocardial injury in coronary artery bypass grafting patients. Eighty patients were assigned to remote preconditioning or control treatment. Ischaemic preconditioning was induced by three 5-min cycles of upper limb ischaemia and reperfusion after anaesthesia induction. Haemodynamic and markers of myocardial damage were analysed preoperatively and over 48 h postoperatively. The cardiac index was higher immediately after remote preconditioning in the main group. There were no differences in other haemodynamic, troponin I and creatine kinase-MB concentrations at any time point between groups. Thus, short-term remote preconditioning improves haemodynamics and does not reduce myocardial injury after coronary artery bypass surgery. Further study of high-risk patients may be needed to fully evaluate the clinical effect of RIPC.

摘要

远程缺血预处理(RIPC)作为一种减少随后持续性心肌缺血发作后心肌损伤的可能性而受到关注。本前瞻性随机研究旨在评估RIPC是否能减轻冠状动脉搭桥术患者的心肌损伤。80名患者被分配到远程预处理组或对照组。缺血预处理通过麻醉诱导后上肢缺血和再灌注的三个5分钟周期来诱导。术前和术后48小时对血流动力学和心肌损伤标志物进行分析。主要组在远程预处理后即刻心脏指数较高。两组在任何时间点的其他血流动力学指标、肌钙蛋白I和肌酸激酶-MB浓度均无差异。因此,短期远程预处理可改善血流动力学,但不能减轻冠状动脉搭桥术后的心肌损伤。可能需要对高危患者进行进一步研究,以全面评估RIPC的临床效果。

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