Kikuchi C, Dosenovic S, Bienengraeber M
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Anesthesiology, Asahikawa Medical University, Asahikawa, Japan.
Br J Pharmacol. 2015 Apr;172(8):2051-61. doi: 10.1111/bph.12981. Epub 2015 Jan 12.
The pharmacological conditioning of the heart with anaesthetics, such as volatile anaesthetics or opioids, is a phenomenon whereby a transient exposure to an anaesthetic agent protects the heart from the harmful consequences of myocardial ischaemia and reperfusion injury. The cellular and molecular mechanisms of anaesthetic conditioning appear largely to mimic those of ischaemic pre- and post-conditioning. Progress has been made on the understanding of the underlying mechanisms although the order of events and the specific targets of anaesthetics that trigger protection are not always clear. In the laboratory, the protection afforded by certain anaesthetics against cardiac ischaemia and reperfusion injury is powerful and reproducible but this has not necessarily translated into similarly robust clinical benefits. Indeed, clinical studies and meta-analyses delivered variable results when comparing in the laboratory setting protective and non-protective anaesthetics. Reasons for this include underlying conditions such as age, obesity and diabetes. Animal models for disease or ageing, human cardiomyocytes derived from stem cells of patients and further clinical studies are employed to better understand the underlying causes that prevent a more robust protection in patients.
使用麻醉剂（如挥发性麻醉剂或阿片类药物）对心脏进行药理学预处理，是一种通过短暂接触麻醉剂来保护心脏免受心肌缺血和再灌注损伤有害后果的现象。麻醉预处理的细胞和分子机制在很大程度上似乎与缺血预处理和后处理相似。尽管引发保护作用的事件顺序和麻醉剂的具体靶点并不总是明确的，但在对潜在机制的理解方面已经取得了进展。在实验室中，某些麻醉剂对心脏缺血和再灌注损伤的保护作用强大且可重复，但这并不一定能转化为同样显著的临床益处。事实上，在实验室环境中比较保护性和非保护性麻醉剂时，临床研究和荟萃分析得出了不同的结果。原因包括年龄、肥胖和糖尿病等潜在状况。利用疾病或衰老的动物模型、源自患者干细胞的人类心肌细胞以及进一步的临床研究，以更好地理解导致患者无法获得更强有力保护的潜在原因。
