Bacci Marcelo R, Vasconcelos Livia Y, Murad Neif, Chagas Antonio Carlos P, Capuano Ana Carolina, Alves Beatriz Ca, Pereira Edimar C, Azzalis Ligia A, Junqueira Virginia Bc, Fonseca Fernando LA
Department of General Practice.
Department of Cardiology.
Int J Gen Med. 2018 May 8;11:175-178. doi: 10.2147/IJGM.S144385. eCollection 2018.
Remote ischemic preconditioning (RIPC) is a procedure that generates a brief period of ischemia followed by reperfusion. The role of RIPC in protecting myocardial ischemia during hemodialysis is not yet established. The aim of the study was to evaluate RIPC myocardial protection as evaluated by ultrasensitive I troponin in hemodialysis outpatients.
A double-blind randomized trial with two groups: intervention submitted to RIPC and control group without RIPC. Intervention group received RIPC in three consecutive hemodialysis sessions. Blood samples were taken before and after each session. Blood urea nitrogen for calculation of single-pool Kt/v and ultrasensitive I troponin were measured to evaluate dialysis adequacy and myocardial injury.
A total of 47 patients were randomized. About 60.8% were men and 54% were diabetic. The mean single-pool Kt/v was 1.51 in the intervention group and 1.49 in control. The ultrasensitive troponin I measured no significant change from the time of collection: before or after dialysis.
The RIPC applied in three consecutive sessions did not demonstrate superiority to control, therefore another study tested RIPC in 12 consecutive sessions with a positive result in myocardial protection. In our study, more than half of the patients were diabetic. Diabetic patients have a trend to show a lower response to RIPC because of the greater presence of collateral coronary circulation. In summary, in this model there was no interference of RIPC in ultrasensitive troponin I values, but troponin had a high negative predictive value for myocardial infarction in all tested models.
远程缺血预处理（RIPC）是一种先产生短暂缺血再进行再灌注的操作。RIPC在血液透析期间保护心肌缺血方面的作用尚未明确。本研究的目的是通过超敏肌钙蛋白I评估血液透析门诊患者中RIPC的心肌保护作用。
一项双盲随机试验，分为两组：接受RIPC的干预组和未接受RIPC的对照组。干预组在连续三次血液透析过程中接受RIPC。每次透析前后采集血样。测量用于计算单池Kt/v的血尿素氮和超敏肌钙蛋白I，以评估透析充分性和心肌损伤。
共有47例患者被随机分组。约60.8%为男性，54%患有糖尿病。干预组的平均单池Kt/v为1.51，对照组为1.49。超敏肌钙蛋白I在采集时（透析前或透析后）无显著变化。
连续三次应用RIPC并未显示出优于对照组，因此另一项研究对连续12次应用RIPC进行了测试，结果显示对心肌有保护作用。在我们的研究中，超过一半的患者患有糖尿病。由于冠状动脉侧支循环较多，糖尿病患者对RIPC的反应有降低的趋势。总之，在该模型中，RIPC对超敏肌钙蛋白I值没有影响，但在所有测试模型中，肌钙蛋白对心肌梗死具有较高的阴性预测价值。
