Tokunaga K
Kyobu Geka. 1989 Jul;42(8 Suppl):647-54.
Perioperative myocardial damage remains the most common cause of morbidity and death following technically successful cardiac operations. Such damage is caused by an imbalance between myocardial energy demand and supply occurring before, during, and after extracorporeal circulation. Meanwhile, since the advent of cardiac surgery, improved methods have been studied to provide a safe, quiet, and bloodless operative field. In recent years, much effort has been devoted to experimental and clinical research to improve myocardial protection during open heart surgery. With understanding on the pathophysiology of ischemic myocardium and reperfusion injury etc. significant advances have been made in myocardial protection during open heart operation, which has allowed a significant reduction in perioperative myocardial injury. In this article, recent developments in myocardial protection and currently accepted clinical techniques have been presented. Furthermore, it has been discussed to concentrate on current topics of controversy and new investigations in this field. Although some cardiac surgeons would argue that very little advanced new information is available in myocardial protection during open heart operation, my opinion is "no". Still now, there are many remained, important problems, such as 1) protective method of immature neonatal myocardium 2) effective substrates to facilitate high energy resumption, and specific scavengers to modify oxygen free radical during reperfusion, and so on. We should expect and await further experimental and clinical trials.
围手术期心肌损伤仍然是心脏手术技术成功后发病和死亡的最常见原因。这种损伤是由体外循环前、中、后心肌能量需求与供应之间的失衡引起的。同时，自心脏手术问世以来，人们一直在研究改进方法以提供一个安全、安静且无血的手术视野。近年来，人们致力于实验和临床研究以改善心脏直视手术中的心肌保护。随着对缺血心肌病理生理学和再灌注损伤等的认识，心脏直视手术中的心肌保护取得了显著进展，这使得围手术期心肌损伤显著减少。本文介绍了心肌保护的最新进展以及目前公认的临床技术。此外，还讨论了关注该领域当前有争议的话题和新的研究。尽管一些心脏外科医生会认为心脏直视手术中心肌保护方面几乎没有新的先进信息，但我的观点是“并非如此”。时至今日，仍存在许多重要问题，例如1）未成熟新生儿心肌的保护方法2）促进高能恢复的有效底物以及再灌注期间修饰氧自由基的特异性清除剂等。我们应该期待并等待进一步的实验和临床试验。
