Bosnjak Zeljko J, Ge Zhi-Dong
Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
F1000Res. 2017 Jun 16;6:928. doi: 10.12688/f1000research.11018.1. eCollection 2017.
Perioperative myocardial ischemia and infarction are the leading causes of morbidity and mortality following anesthesia and surgery. The discovery of endogenous cardioprotective mechanisms has led to testing of new methods to protect the human heart. These approaches have included ischemic pre-conditioning, per-conditioning, post-conditioning, and remote conditioning of the myocardium. Pre-conditioning and per-conditioning include brief and repetitive periods of sub-lethal ischemia before and during prolonged ischemia, respectively; and post-conditioning is applied at the onset of reperfusion. Remote ischemic conditioning involves transient, repetitive, non-lethal ischemia and reperfusion in one organ or tissue (remote from the heart) that renders myocardium more resistant to lethal ischemia/reperfusion injury. In healthy, young hearts, many conditioning maneuvers can significantly increase the resistance of the heart against ischemia/reperfusion injury. The large multicenter clinical trials with ischemic remote conditioning have not been proven successful in cardiac surgery thus far. The lack of clinical success is due to underlying risk factors that interfere with remote ischemic conditioning and the use of cardioprotective agents that have activated the endogenous cardioprotective mechanisms prior to remote ischemic conditioning. Future preclinical research using remote ischemic conditioning will need to be conducted using comorbid models.
围手术期心肌缺血和梗死是麻醉和手术后发病和死亡的主要原因。内源性心脏保护机制的发现促使人们对保护人类心脏的新方法进行测试。这些方法包括心肌缺血预处理、预适应、后处理和远程预处理。预处理和预适应分别包括在长时间缺血之前和期间进行短暂且重复的亚致死性缺血；后处理则在再灌注开始时应用。远程缺血预处理涉及在一个器官或组织（远离心脏）中进行短暂、重复、非致死性的缺血和再灌注，从而使心肌对致死性缺血/再灌注损伤更具抵抗力。在健康的年轻心脏中，许多预处理操作可显著增强心脏对缺血/再灌注损伤的抵抗力。迄今为止，大型多中心缺血远程预处理临床试验在心脏手术中尚未取得成功。临床未成功的原因在于存在干扰远程缺血预处理的潜在危险因素，以及在远程缺血预处理之前使用了激活内源性心脏保护机制的心脏保护剂。未来使用远程缺血预处理的临床前研究将需要使用共病模型来进行。
