Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark.
Section of Experimental Animal Models, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
BJS Open. 2024 Jul 2;8(4). doi: 10.1093/bjsopen/zrae067.
Surgical stress may lead to postsurgical hypercoagulability, endothelial dysfunction and systemic inflammation, which can impact on patient recovery. Remote ischaemic preconditioning is a procedure that activates the body's endogenous defences against ischaemia and reperfusion injury. Studies have suggested that remote ischaemic preconditioning has antithrombotic, antioxidative and anti-inflammatory effects. The hypothesis was that remote ischaemic preconditioning reduces surgery-induced systemic stress response.
During a 24-month period (2019-2021), adult patients undergoing subacute laparoscopic cholecystectomy due to acute cholecystitis were randomized to remote ischaemic preconditioning or control. Remote ischaemic preconditioning was performed less than 4 h before surgery on the upper arm. It consisted of four cycles of 5 min ischaemia and 5 min reperfusion. The gene expression of 750 genes involved in inflammatory processes, oxidative stress and endothelial function was investigated preoperatively and 2-4 h after surgery in both groups. In addition, changes in 20 inflammation- and vascular trauma-associated proteins were assessed preoperatively, 2-4 h after surgery and 24 h after surgery.
A total of 60 patients were randomized. There were no statistically significant differences in gene expression 2-4 h after surgery between the groups (P > 0.05). Remote ischaemic preconditioning did not affect concentrations of circulating proteins up to 24 h after surgery (P > 0.05).
The study did not demonstrate any effect of remote ischaemic preconditioning on expression levels of the chosen genes or in circulating immunological cytokines and vascular trauma-associated proteins up to 24 h after subacute laparoscopic cholecystectomy in patients with acute cholecystitis.
手术应激可能导致术后高凝状态、内皮功能障碍和全身炎症，从而影响患者的康复。远程缺血预处理是一种激活机体对缺血再灌注损伤的内源性防御机制的程序。研究表明，远程缺血预处理具有抗血栓、抗氧化和抗炎作用。假设是远程缺血预处理可减轻手术引起的全身应激反应。
在 24 个月（2019-2021 年）期间，患有急性胆囊炎的成年患者因亚急性腹腔镜胆囊切除术而随机分为远程缺血预处理组或对照组。在手术前不到 4 小时，在上臂进行远程缺血预处理。它包括四个循环的 5 分钟缺血和 5 分钟再灌注。术前和术后 2-4 小时两组均检测与炎症过程、氧化应激和内皮功能相关的 750 个基因的表达。此外，术前、术后 2-4 小时和术后 24 小时评估 20 种与炎症和血管损伤相关的蛋白质的变化。
共随机分配了 60 例患者。术后 2-4 小时两组基因表达无统计学差异（P>0.05）。远程缺血预处理对术后 24 小时内循环蛋白浓度没有影响（P>0.05）。
该研究表明，在急性胆囊炎患者亚急性腹腔镜胆囊切除术后 24 小时内，远程缺血预处理对所选基因的表达水平或循环免疫细胞因子和血管损伤相关蛋白没有任何影响。
