吸入气体作为心脏骤停后综合征的治疗方法:近期进展的叙述性综述
Inhaled Gases as Therapies for Post-Cardiac Arrest Syndrome: A Narrative Review of Recent Developments.
作者信息
Hayashida Kei, Miyara Santiago J, Shinozaki Koichiro, Takegawa Ryosuke, Yin Tai, Rolston Daniel M, Choudhary Rishabh C, Guevara Sara, Molmenti Ernesto P, Becker Lance B
机构信息
Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, United States.
Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States.
出版信息
Front Med (Lausanne). 2021 Jan 14;7:586229. doi: 10.3389/fmed.2020.586229. eCollection 2020.
Despite recent advances in the management of post-cardiac arrest syndrome (PCAS), the survival rate, without neurologic sequelae after resuscitation, remains very low. Whole-body ischemia, followed by reperfusion after cardiac arrest (CA), contributes to PCAS, for which established pharmaceutical interventions are still lacking. It has been shown that a number of different processes can ultimately lead to neuronal injury and cell death in the pathology of PCAS, including vasoconstriction, protein modification, impaired mitochondrial respiration, cell death signaling, inflammation, and excessive oxidative stress. Recently, the pathophysiological effects of inhaled gases including nitric oxide (NO), molecular hydrogen (H), and xenon (Xe) have attracted much attention. Herein, we summarize recent literature on the application of NO, H, and Xe for treating PCAS. Recent basic and clinical research has shown that these gases have cytoprotective effects against PCAS. Nevertheless, there are likely differences in the mechanisms by which these gases modulate reperfusion injury after CA. Further preclinical and clinical studies examining the combinations of standard post-CA care and inhaled gas treatment to prevent ischemia-reperfusion injury are warranted to improve outcomes in patients who are being failed by our current therapies.
尽管近期在心脏骤停后综合征(PCAS)的管理方面取得了进展,但复苏后无神经后遗症的存活率仍然很低。全身缺血,继之以心脏骤停(CA)后的再灌注,是PCAS的成因,目前仍缺乏成熟的药物干预措施。研究表明,在PCAS的病理过程中,许多不同的过程最终可导致神经元损伤和细胞死亡,包括血管收缩、蛋白质修饰、线粒体呼吸受损、细胞死亡信号传导、炎症和过度氧化应激。最近,包括一氧化氮(NO)、分子氢(H)和氙气(Xe)在内的吸入气体的病理生理效应引起了广泛关注。在此,我们总结了关于应用NO、H和Xe治疗PCAS的近期文献。最近的基础和临床研究表明,这些气体对PCAS具有细胞保护作用。然而,这些气体调节CA后再灌注损伤的机制可能存在差异。有必要进一步开展临床前和临床研究,探讨标准CA后护理与吸入气体治疗相结合以预防缺血再灌注损伤的方法,从而改善目前治疗效果不佳的患者的预后。
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