Fuhrman Dana Y, Kellum John A
All authors: Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Pediatr Crit Care Med. 2016 Aug;17(8):e371-9. doi: 10.1097/PCC.0000000000000836.
In this study, we will review the most recently proposed mechanisms for remote ischemic preconditioning and summarize the past 10 years of clinical studies, as well as potential reasons for why, despite over 20 years of research on remote ischemic preconditioning, it is not routinely used in the pediatric critical care patient. In addition, future directions for remote ischemic preconditioning research will be discussed.
We searched the PubMed database for relevant literature.
In PubMed, the search terms "ischemic preconditioning" and "remote preconditioning" were used. Randomized controlled trials published from 2006 until the present time that used a blood pressure cuff to induce remote ischemic preconditioning were included. We also reviewed the reference lists of the articles found in the PubMed search and included those thought to contribute to the objectives. All studies pertaining to remote ischemic preconditioning that included pediatric patients were reviewed.
Differences in study outcomes in the effect of remote ischemic preconditioning on organ protection have been reported and may have played a large role in limiting the translation of findings into routine clinical practice. Ongoing efforts to protocolize the remote ischemic preconditioning technique in large multicenter trials with clearly delineated patient risk groups, including the use of biomarkers for enrichment, may help to ultimately determine if this procedure can be safely and effectively used for critically ill children.
在本研究中，我们将回顾最近提出的远程缺血预处理机制，总结过去10年的临床研究，以及尽管对远程缺血预处理进行了20多年的研究，但它仍未在儿科重症监护患者中常规使用的潜在原因。此外，还将讨论远程缺血预处理研究的未来方向。
我们在PubMed数据库中搜索了相关文献。
在PubMed中，使用了搜索词“缺血预处理”和“远程预处理”。纳入了2006年至今发表的使用血压袖带诱导远程缺血预处理的随机对照试验。我们还查阅了在PubMed搜索中找到的文章的参考文献列表，并纳入了那些被认为有助于实现研究目标的文献。对所有涉及包括儿科患者在内的远程缺血预处理的研究进行了综述。
已有报道称，远程缺血预处理对器官保护作用的研究结果存在差异，这可能在很大程度上限制了研究结果转化为常规临床实践。正在进行的努力，即在大型多中心试验中对远程缺血预处理技术进行标准化，明确划分患者风险组，包括使用生物标志物进行富集，可能有助于最终确定该程序是否可安全有效地用于重症儿童。
