Feige Katharina, Torregroza Carolin, Gude Milena, Maddison Patrick, Stroethoff Martin, Roth Sebastian, Lurati Buse Giovanna, Hollmann Markus W, Huhn Ragnar
Department of Anesthesiology, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Meiberdreef 9, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2022 Mar 7;11(5):1450. doi: 10.3390/jcm11051450.
The cardioprotective effect of remote ischemic preconditioning (RIPC) is well detectable in experimental studies but not in clinical trials. Propofol, a commonly used sedative, is discussed to negatively influence the release of humoral factors after RIPC. Further, results from experimental and clinical trials suggest various comorbidities interact with inducible cardioprotective properties of RIPC. In the present study, we went back from bedside to bench to investigate, in male patients undergoing CABG surgery, whether (1) humoral factors are released after RIPC during propofol-free anesthesia and/or (2) DM interacts with plasma factor release. Blood samples were taken from male patients with and without DM undergoing CABG surgery before (control) and after RIPC (RIPC). To investigate the release of cardioprotective humoral factors into the plasma, isolated perfused hearts of young rats ( = 5 per group) were used as a bioassay. The hearts were perfused with patients' plasma without (Con) and with RIPC (RIPC) for 10 min (1% of coronary flow) before global ischemia and reperfusion. In additional groups, the plasma of patients with DM was administered (Con DM, RIPC DM). Infarct size was determined by TTC staining. Propofol-free RIPC plasma of male patients without DM showed an infarct size of 59 ± 5% compared to 61 ± 13% with Con plasma ( = 0.973). Infarct sizes from patients with DM showed similar results (RIPC DM: 55 ± 3% vs. Con DM: 56 ± 4%; = 0.995). The release of humoral factors into the blood after RIPC in patients receiving propofol-free anesthesia undergoing CABG surgery did not show any cardioprotective properties independent of a pre-existing diabetes mellitus.
远程缺血预处理（RIPC）的心脏保护作用在实验研究中很容易检测到，但在临床试验中却未得到证实。丙泊酚是一种常用的镇静剂，有研究认为它会对RIPC后体液因子的释放产生负面影响。此外，实验和临床试验结果表明，各种合并症会与RIPC的诱导性心脏保护特性相互作用。在本研究中，我们从临床回到实验室，以接受冠状动脉旁路移植术（CABG）的男性患者为研究对象，调查（1）在无丙泊酚麻醉期间，RIPC后是否会释放体液因子，和/或（2）糖尿病（DM）是否会与血浆因子释放相互作用。在接受CABG手术的男性糖尿病患者和非糖尿病患者术前（对照）和RIPC后（RIPC）采集血样。为了研究心脏保护体液因子向血浆中的释放情况，使用年轻大鼠的离体灌注心脏（每组 = 5只）作为生物测定模型。在全心缺血和再灌注前，将患者未进行RIPC（对照）和进行RIPC（RIPC）的血浆以10分钟（冠状动脉血流量的1%）灌注心脏。在其他组中，给予糖尿病患者的血浆（对照DM，RIPC DM）。通过TTC染色确定梗死面积。无糖尿病男性患者的无丙泊酚RIPC血浆梗死面积为59±5%，而对照血浆为61±13%（P = 0.973）。糖尿病患者的梗死面积结果相似（RIPC DM：55±3% vs. 对照DM：56±4%；P = 0.995）。在接受无丙泊酚麻醉的CABG手术患者中，RIPC后体液因子向血液中的释放未显示出任何独立于糖尿病的心脏保护特性。
