Brown W M, Horsley W S, Gott J P, Bufkin B L, Guyton R A
Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
Semin Thorac Cardiovasc Surg. 1995 Oct;7(4):191-7.
An increasing body of evidence suggests that the majority of myocardial injury that occurs during ischemia and reperfusion is effected during the reperfusion phase. There is also convincing evidence that controlling the conditions of reperfusion and composition of the reperfusate can markedly minimize the ultimate injury following an ischemic insult. Medical reperfusion (PTCA, thrombolytics) has the disadvantage of reperfusing with unmodified whole blood under uncontrolled conditions, whereas surgical reperfusion allows very stringent control of both. A brief review of the pathophysiology of ischemia and reperfusion is presented to gain insight into the mechanisms of injury that can be counteracted by controlling the conditions of reperfusion and composition of the reperfusate. Surgical protocols that have been developed independently at two separate institutions are outlined, along with the experimental data supporting each method, and the advantages and disadvantages of each method. This information should allow implementation of a rational plan of myocardial protection for resuscitation of the ischemic myocardium when performing coronary artery bypass grafting in the setting of acute myocardial ischemia and infarction.
越来越多的证据表明，缺血和再灌注期间发生的大多数心肌损伤是在再灌注阶段造成的。也有令人信服的证据表明，控制再灌注条件和再灌注液成分可以显著减少缺血性损伤后的最终损伤。药物再灌注（经皮冠状动脉腔内血管成形术、溶栓剂）的缺点是在不受控制的条件下用未改良的全血进行再灌注，而手术再灌注则允许对两者进行非常严格的控制。本文简要回顾了缺血和再灌注的病理生理学，以深入了解通过控制再灌注条件和再灌注液成分可以对抗的损伤机制。概述了在两个不同机构独立制定的手术方案，以及支持每种方法的实验数据，以及每种方法的优缺点。这些信息应有助于在急性心肌缺血和梗死的情况下进行冠状动脉旁路移植术时，为缺血心肌复苏制定合理的心肌保护计划。
