From the Department of Anesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany.
Department of Anesthesiology, Amsterdam University Medical Centers (AUMC), Location Academic Medical Center, Amsterdam, the Netherlands.
Anesth Analg. 2020 Dec;131(6):1751-1764. doi: 10.1213/ANE.0000000000005234.
Perioperative cardioprotection aims to minimize the consequences of myocardial ischemia-reperfusion injury. In isolated tissue and animal experiments, several treatments have been identified providing cardioprotection. Some of these strategies have been confirmed in clinical proof-of-concept studies. However, the final translation of cardioprotective strategies to really improve clinical outcome has been disappointing: large randomized controlled clinical trials mostly revealed inconclusive, neutral, or negative results. This review provides an overview of the currently available evidence regarding clinical implications of perioperative cardioprotective therapies from an anesthesiological perspective, highlighting nonpharmacological as well as pharmacological strategies. We discuss reasons why translation of promising experimental results into clinical practice and outcome improvement is hampered by potential confounders and suggest future perspectives to overcome these limitations.
围术期心肌保护旨在将心肌缺血再灌注损伤的后果降到最低。在离体组织和动物实验中，已经确定了几种提供心肌保护的治疗方法。其中一些策略已在临床概念验证研究中得到证实。然而，将心肌保护策略真正转化为改善临床结局的效果却令人失望：大型随机对照临床试验大多得出不确定、中性或负面的结果。本文从麻醉学角度综述了围术期心肌保护治疗的临床意义，重点介绍了非药物和药物策略。我们讨论了为什么有希望的实验结果转化为临床实践和改善结局受到潜在混杂因素的阻碍，并提出了克服这些局限性的未来展望。
