Thuret R, Saint Yves T, Tillou X, Chatauret N, Thuillier R, Barrou B, Billault C
Inserm U1082; université de Poitiers, faculté de Médecine et Pharmacie, 86000 Poitiers, France; Service d'Urologie et de Transplantation rénale, hôpital Lapeyronie, 34295 Montpellier, France.
Inserm U1082; université de Poitiers, faculté de Médecine et Pharmacie, 86000 Poitiers, France; Service d'Urologie, CHU de Poitiers La Miletrie, 86021 Poitiers, France.
Prog Urol. 2014 Jun;24 Suppl 1:S56-61. doi: 10.1016/S1166-7087(14)70065-X.
Ischemic conditioning is a phenomenon through which short sequences of ischemia-reperfusion applied to an organ confer some degree of protection towards future ischemic insults. This phenomenon was first observed in the mid-1980s in cardiac surgery, and has been since widely studied in different settings. Different sort of ischemic conditioning exist: local vs remote, direct or pharmacological, and with different timeframes of protection. Ischemic conditioning seems especially suited to applications in transplantation since schedules of both cold and warm ischemia, as well as reperfusion, are carefully and easily controlled, and the benefits of protecting fragile organs against ischemia-reperfusion injuries might help widen the pool of possible grafts and ensure better graft function and survival. The pathways through which ischemic conditioning work are many, offering both preservation of cell energy, protection against oxidative stress, better blood flow to organs and protection against apoptosis. In the field of pharmacological conditioning, which tries to mimic the protective effects of traditional ischemic conditioning without the potential side-effects associated with vessel clamping, many common-use drugs including anesthetics have been shown to be effective. Significant results have been obtained in small animal models, but while ischemic conditioning is successfully used in cardiac surgery, studies in large animal models and human applications in liver and kidney transplantation are still inconclusive.
缺血预处理是一种现象，通过对器官施加短暂的缺血-再灌注序列，可使其对未来的缺血性损伤具有一定程度的保护作用。这一现象于20世纪80年代中期在心脏手术中首次被观察到，此后在不同的环境中得到了广泛研究。存在不同类型的缺血预处理：局部与远程、直接或药理学的，以及具有不同的保护时间框架。缺血预处理似乎特别适用于移植领域，因为冷缺血和热缺血以及再灌注的时间安排都可以仔细且容易地控制，保护脆弱器官免受缺血-再灌注损伤的益处可能有助于扩大潜在移植物的范围，并确保更好的移植物功能和存活。缺血预处理发挥作用的途径有很多，包括保存细胞能量、抵抗氧化应激、改善器官血流以及防止细胞凋亡。在药理学预处理领域，该领域试图模拟传统缺血预处理的保护作用而不产生与血管夹闭相关的潜在副作用，许多常用药物（包括麻醉剂）已被证明是有效的。在小动物模型中已取得显著成果，但虽然缺血预处理已成功应用于心脏手术，但在大动物模型以及肝脏和肾脏移植的人体应用方面的研究仍无定论。
