Zhang Lianqin, Zhou Kang, Gu Tianchu, Xu Jingjing, Shi Mengzhu, Zhu Jiang, Liu Jindong
Department of Anesthesiology The Second Affiliated Hospital of Soochow University, Soochow, Jiangsu 215008, China.
Jiangsu Province Key Laboratory of Anesthesiology Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
Cardiovasc Ther. 2024 Jun 24;2024:9889995. doi: 10.1155/2024/9889995. eCollection 2024.
Remote ischemic preconditioning (RIPC) is reported to have early-phase and delayed-phase organ-protective effects. Previous studies have focused on the organ protection of a single RIPC protocol, and the clinical outcomes remain uncertain. Whether the modified RIPC (mRIPC) protocol performed repeatedly provides cardiopulmonary protection is still uncertain. In this single-center, randomized, controlled trial, 86 patients undergoing elective mitral valve replacement (MVR) surgery were randomized 1:1 to receive either mRIPC or no ischemic preconditioning (control). Three cycles of 5 min ischemia and 5 min reperfusion induced by a blood pressure cuff served as the RIPC stimulus. mRIPC was induced at the following three time points: 24 h, 12 h, and 1 h before surgery. Blood samples were withdrawn at 10 min after intubation (T0), at 1 h after aortic declamping (T1), and at 6 h (T2), 12 h (T3), and 24 h (T4) after surgery to measure the serum concentrations of myocardial enzymes and other biomarkers, including cardiac troponin I (cTnI), which was the primary endpoint of this study. Creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), inotropic score (IS), and inflammatory mediators were also measured. Blood gas analysis was conducted to calculate the PaO/FiO ratio and A-aDO, and the incidence of acute lung injury (ALI) was also recorded. mRIPC significantly decreased the serum concentrations of cTnI, CK-MB, and LDH at T2, T3, and T4 ( < 0.01), and the IS decreased compared with that in the control group (12.0 ± 1.0 vs. 14.2 ± 1.1, < 0.01). In addition, the incidence of ALI in the mRIPC group was decreased (32.6% vs. 51.2%, = 0.039), and the PaO/FiO was higher at T4 ( < 0.05). Compared with those in the control group, the levels of interleukin-6 (IL-6) and tumor necrosis factor- (TNF-) were decreased at T1, T2, T3, and T4 ( < 0.05) in the mRIPC group, and the level of IL-10 increased at the same time. mRIPC decreased the incidence of myocardial and lung injury in MVR surgery, providing new evidence for the clinical application of RIPC in valve surgery. ClinicalTrials.gov (NCT01406678).
据报道，远程缺血预处理（RIPC）具有早期和延迟期器官保护作用。以往的研究主要集中在单一RIPC方案的器官保护上，临床结果仍不确定。重复进行的改良RIPC（mRIPC）方案是否能提供心肺保护仍不明确。在这项单中心、随机、对照试验中，86例行择期二尖瓣置换术（MVR）的患者按1:1随机分组，分别接受mRIPC或无缺血预处理（对照组）。通过血压袖带诱导3个周期的5分钟缺血和5分钟再灌注作为RIPC刺激。mRIPC在以下三个时间点诱导：手术前24小时、12小时和1小时。在插管后10分钟（T0）、主动脉夹闭后1小时（T1）以及术后6小时（T2）、12小时（T3）和24小时（T4）采集血样，以测量心肌酶和其他生物标志物的血清浓度，包括心肌肌钙蛋白I（cTnI），这是本研究的主要终点。还测量了肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、变力评分（IS）和炎症介质。进行血气分析以计算PaO/FiO比值和A-aDO，并记录急性肺损伤（ALI）的发生率。mRIPC在T2、T3和T4时显著降低了cTnI、CK-MB和LDH的血清浓度（P<0.01），与对照组相比，IS降低（12.0±1.0 vs. 14.2±1.1，P<0.01）。此外，mRIPC组ALI的发生率降低（32.6% vs. 51.2%，P = 0.039），T4时PaO/FiO更高（P<0.05）。与对照组相比，mRIPC组在T1、T2、T3和T4时白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平降低（P<0.05），同时IL-10水平升高。mRIPC降低了MVR手术中心肌和肺损伤的发生率，为RIPC在瓣膜手术中的临床应用提供了新的证据。ClinicalTrials.gov（NCT01406678）。
