Stoppe C, Meybohm P, Coburn M, Goetzenich A
Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Institut für Biochemie und Molekulare Zellbiologie, RWTH Aachen, Aachen, Deutschland.
Anaesthesist. 2016 Mar;65(3):169-82. doi: 10.1007/s00101-016-0141-z.
Despite substantial success in the anesthetic and surgical management of cardiac surgery, patients frequently show postoperative complications and organ dysfunctions. This is highly relevant for mid- to long-term outcomes.
To evaluate cardioprotective strategies that may offer effective protection in vulnerable cardiac surgery patients.
To demonstrate recent cardioprotective approaches for cardiac surgery patients, aiming to modulate the body's own protective mechanisms in cardiac surgery patients.
Both cardioplegia and hypothermia belong to the well-established protective strategies during myocardial ischemia. Volatile anesthetics have been repeatedly shown to improve the left ventricular function and reduce the extent of myocardial injury compared to a control group with intravenous anesthesia. Furthermore, patients receiving volatile anesthetics showed a significantly shortened stay in the ICU and in hospital after cardiac surgery. In contrast, numerous other protective strategies failed translation into the clinical practice. Despite the published reduction of troponin release after remote ischemic preconditioning, two recent large-scale randomized multicenter trials were unable to demonstrate a clinical benefit.
Beside the use of cardioplegia and hypothermia, the use of volatile anesthetics is well-established during cardiac surgery because of its conditioning and protective properties. Regardless of the promising results derived from experimental studies and small clinical trials, the majority of other approaches failed to translate their findings into the clinic. Therefore, systematic experimental studies are needed to identify potential confounding factors that may affect the protective effects.
尽管心脏手术的麻醉和手术管理取得了巨大成功，但患者术后仍经常出现并发症和器官功能障碍。这与中长期预后高度相关。
评估可能为易发生并发症的心脏手术患者提供有效保护的心脏保护策略。
展示针对心脏手术患者的最新心脏保护方法，旨在调节心脏手术患者自身的保护机制。
心脏停搏和低温均属于心肌缺血期间成熟的保护策略。与静脉麻醉的对照组相比，挥发性麻醉剂已多次显示可改善左心室功能并减少心肌损伤程度。此外，接受挥发性麻醉剂的患者心脏手术后在重症监护病房（ICU）和医院的停留时间明显缩短。相比之下，许多其他保护策略未能转化为临床实践。尽管有研究报道远程缺血预处理后肌钙蛋白释放减少，但最近两项大规模随机多中心试验未能证明其临床益处。
除了使用心脏停搏和低温外，由于其调节和保护特性，挥发性麻醉剂在心脏手术中的应用已得到充分确立。尽管实验研究和小型临床试验取得了令人鼓舞的结果，但大多数其他方法未能将其研究结果转化为临床应用。因此，需要进行系统的实验研究，以确定可能影响保护效果的潜在混杂因素。
