Jin Xiuling, Wang Liangrong, Li Liling, Zhao Xiyue
Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China.
Exp Ther Med. 2019 Mar;17(3):2099-2106. doi: 10.3892/etm.2019.7192. Epub 2019 Jan 21.
Remote ischemic pre-conditioning (RIPC) may have a protective effect on myocardial injury associated with cardiac bypass surgery (CPB). The objective of the present study was to investigate the effect of RIPC on ischemia/reperfusion (I/R) injury and to assess the underlying mechanisms. A total of 241 patients who underwent valve replacement were randomly assigned to receive either RIPC (n=121) or control group (n=120). The primary endpoint was peri-operative myocardial injury (PMI), which was determined by serum Highly sensitive cardiac troponin T (hsTnT). The secondary endpoint was the blood gas indexes, acute lung injury and length of intensive care unit stay, length of hospital stay and major adverse cardiovascular events. The results indicated that in comparison with control group, RIPC treatment reduced the levels of hsTnT at 6 and 24 h post-CPB (P<0.001), as well as the alveolar-arterial oxygen pressure difference and respiratory index after CPB. Furthermore, RIPC reduced the incidence of acute lung injury by 15.3% (54.1% in the control group vs. 41.3% in the RIPC group, P=0.053). It was indicated that RIPC provided myocardial and pulmonary protection during CPB. In addition, the length of the intensive care unit and hospital stay was reduced by RIPC. Mechanistic investigation revealed a reduced content of soluble intercellular adhesion molecule-1, endothelin-1 and malondialdehyde, as well as elevated levels of nitric oxide in the RIPC group compared with those in the control group. This indicated that RIPC protected against I/R injury associated with CPB through reducing the inflammatory response and oxidative damage, as well as improving pulmonary vascular tension. In conclusion, RIPC reduced myocardial and pulmonary injury associated with CPB. This protective effect may be associated with the inhibition of the inflammatory response and oxidative injury. The present study proved the efficiency of this approach in reducing ischemia/reperfusion injury associated with cardiac surgery. Clinical trial registry no. ChiCTR1800015393.
远程缺血预处理（RIPC）可能对与心脏搭桥手术（CPB）相关的心肌损伤具有保护作用。本研究的目的是探讨RIPC对缺血/再灌注（I/R）损伤的影响，并评估其潜在机制。共有241例行瓣膜置换术的患者被随机分为RIPC组（n = 121）或对照组（n = 120）。主要终点是围手术期心肌损伤（PMI），通过血清高敏心肌肌钙蛋白T（hsTnT）测定。次要终点是血气指标、急性肺损伤、重症监护病房住院时间、住院时间和主要不良心血管事件。结果表明，与对照组相比，RIPC治疗降低了CPB后6小时和24小时的hsTnT水平（P<0.001），以及CPB后的肺泡-动脉氧分压差和呼吸指数。此外，RIPC使急性肺损伤的发生率降低了15.3%（对照组为54.1%，RIPC组为41.3%，P = 0.053）。表明RIPC在CPB期间提供心肌和肺保护。此外，RIPC缩短了重症监护病房和住院时间。机制研究显示，与对照组相比，RIPC组可溶性细胞间黏附分子-1、内皮素-1和丙二醛含量降低，一氧化氮水平升高。这表明RIPC通过减轻炎症反应和氧化损伤以及改善肺血管张力来预防与CPB相关的I/R损伤。总之，RIPC减轻了与CPB相关的心肌和肺损伤。这种保护作用可能与抑制炎症反应和氧化损伤有关。本研究证明了该方法在减轻与心脏手术相关的缺血/再灌注损伤方面的有效性。临床试验注册号：ChiCTR1800015393。
