CAJ | 학술논문

背景虽然缺血预处理(ischemia preconditioning,IPC)仍然是目前已知的最强大内源性心肌保护措施,但是各种原因其临床应用受到了限制.远隔于心脏之外的其他器官或组织经历短暂缺血后可使心肌对后继的长时间缺血更加耐受,即远隔缺血预处理(remote ischemic preconditioning,RIPC)的心肌保护作用.目前的研究已经将远隔处理的保护作用从单一的心肌保护领域扩展到了对全身众多器官或组织的保护作用中.在将远隔处理推荐作为临床工作的常规措施之前,仍需更多大规模的临床研究评估和优化其保护作用.目的探讨远隔处理的心肌保护作用及研究进展.内容对远隔处理的发现、发展过程中的文献进行综述,并通过现有研究结果剖析远隔处理内在作用机制.趋向远隔处理具有较光明的临床应用前景,通过对其作用机制和影响因素进行深入研究有助于获得更好的心肌保护干预策略.
배경 수연결혈예처리(ischemia preconditioning,IPC)잉연시목전이지적최강대내원성심기보호조시,단시각충원인기림상응용수도료한제.원격우심장지외적기타기관혹조직경력단잠결혈후가사심기대후계적장시간결혈경가내수,즉원격결혈예처리(remote ischemic preconditioning,RIPC)적심기보호작용.목전적연구이경장원격처리적보호작용종단일적심기보호영역확전도료대전신음다기관혹조직적보호작용중.재장원격처리추천작위림상공작적상규조시지전,잉수경다대규모적림상연구평고화우화기보호작용.목적 탐토원격처리적심기보호작용급연구진전.내용대원격처리적발현、발전과정중적문헌진행종술,병통과현유연구결과부석원격처리내재작용궤제.추향 원격처리구유교광명적림상응용전경,통과대기작용궤제화영향인소진행심입연구유조우획득경호적심기보호간예책략.
Background Direct ischemia preconditioning (IPC) is the most powerful endogenous cardioprotective intervention up to now.But its clinical application has been hampered by the requirement to intervene before the onset of acute myocardial ischemia.Experimental data suggest that remote ischemic preconditioning (RIPC),where brief ischemia in one remote organ or tissue confers resistance to subsequent sustained ischemic insults in another tissue.The concept of remote organ protection has now been extended beyond that of solely protecting the heart to providing a general form of inter-organ protection against ischemia reperfusion injury.Small randomized trials in humans undergoing percutaneous coronary intervention or major surgery suggest that RIPC induced by brief limb ischemia significantly reduces myocairdial injury.However,large-scale clinical trials to assess and optimize the effects of remote conditioning on mortality and morbidity are required before it can be recommended for routine clinical use. Objective We will introduce the advances of myocardium protection of remote preconditioning. Content This article reviewed the history and evolution of the remote preconditioning,and the underlying mechanism was discussed according to the results of available researches. Trend As an effective strategy for myocardial protection,remote preconditioning shows very good perspective of clinical application.The potential mechanisms underlying its cardioprotective effect merit further investigation to find better myocardial protective strategy.