肾脏缺血预适应

缺血预适应是多种器官存在的一种自我保护现象，能够减轻器官的缺血性损伤。研究动物肾脏缺血预适应的现状、机制及人类肾脏缺血预适应的问题无疑是临床科学的巨大进步。     

肾脏缺血预适应

缺血预适应是多种器官存在的一种自我保护现象 ,能够减轻器官的缺血性损伤。研究动物肾脏缺血预适应的现状、机制及人类肾脏缺血预适应的问题无疑是临床科学的巨大进步     

肝脏的缺血预适应

肝脏的缺血/再灌注(ischemia/reprefusion,I/R)损伤是肝移植和肝胆外科中尚需解决的一个重要课题，肝脏缺血预适应（ischemic preconditioning,IP）能增强肝脏对随后长时间缺血的耐受性，有助于减轻肝脏I/R损伤，本文综述了肝脏IP的研究进展。     

缺血预适应的研究进展

1986年Murry等[1]首次提出:心肌在经受了一次或多次短暂的缺血再灌注后对随后更长时间致死性缺血再灌注损伤的耐受性增强.并将此现象命名为缺血预适应(Ischemic preconditioning IPC).经过15年大量的动物实验及临床试验,对IPC的特点、触发因素、发生机理及结果进行了深入的研究,使人们对缺血再灌注损伤及IPC有了深一步的认识.     

缺血缺氧性适应研究进展

缺血缺氧性适应作为机体的一种内源性保护机制,在临床抗缺血缺氧中的作用日益受到重视。本文对缺血缺氧性适应及其可能的机制进行了综述。     

缺血预适应对缺血-再灌注心肌细胞的保护作用

目的观察缺血预处理（IPC）对心肺转流（CPB）中缺血-再灌注心肌损伤及心功能恢复的影响。方法将72只健康家猫随机均分为：单纯CPB组、缺血-再灌注组和IPC组。在猫CPB模型的基础上,测定猫心肌丙二醛（MDA）含量、血清乳酸脱氢酶（LDH）水平和心肌组织磷脂酶A2（PLA2）活性的变化,观察术中心功能的变化。结果IPC组CPB中的血清LDH浓度、心肌MDA含量和心肌组织PLA2活性均明显低于缺血-再灌注组,心脏复跳后各心功能指标的恢复明显优于缺血-再灌注组。结论IPC可减轻CPB中缺血-再灌注心肌细胞的损伤,有利于术后早期心功能的恢复。     

心肌缺血预适应延迟相研究进展

心肌缺血预处理是指一次或几次短暂重复的缺血/再灌注,能够增强心肌对以后较长时间心肌缺血缺氧的耐受能力,减轻心肌缺血/再灌注损伤。根据对心肌保护作用出现的时间,可将其分为预处理的快速相和延迟相。近几年来人们对心肌缺血预处理延迟相做了大量研究,现综述如下。     

晚期预适应在肾脏缺血/再灌注损伤中的作用

本文简要综述近几年来晚期缺血预适应在肾脏缺血/再灌注损伤中的保护机制以及临床应用研究进展.     

缺血预处理在肝脏外科中的应用

近年来缺血预处理已经从动物实验阶段走向临床应用，但其如何保护肝脏拮抗热缺血再灌注损伤或移植肝在保存过程中冷缺血损伤的机制还未完全明确，在肝脏外科临床的应用中也还存在不同观点。文中就缺血预处理在肝脏外科临床中的应用情况作一综述。     

肝脏的缺血预适应(文献综述)

肝脏的缺血 /再灌注 (ischemia/ reprefusion,I/ R)损伤是肝移植和肝胆外科中尚需解决的一个重要课题。肝脏缺血预适应 (ischemic preconditioning,IP)能增强肝脏对随后长时间缺血的耐受性 ,有助于减轻肝脏 I/ R损伤。本文综述了肝脏 IP的研究进展     

Remote ischemic preconditioning in major vascular surgery

Remote ischemic preconditioning is a physiologic mechanism in mammalian species whereby brief exposure to nonlethal ischemia in one tissue confers protection against a prolonged ischemic insult in a distant tissue. First described almost 15 years ago, it has been slow to translate into clinical practice. Several clinical trials have recently reported that remote ischemic preconditioning reduces myocardial injury after major cardiovascular surgery. In addition, a randomized trial in patients undergoing open abdominal aortic aneurysm repair reported a significant reduction in perioperative myocardial infarctions. Remote ischemic preconditioning is easily performed and likely to prove highly cost-effective. large-scale trials of the technique are warranted in patients undergoing major vascular surgery.     

缺血预处理在肠缺血/再灌注损伤中的研究进展

缺血预处理是近年来提出的一种新的肠缺血/再灌注损伤的保护方法,即使在小肠长时间缺血/再灌注之前,进行一次或多次短暂的缺血,再灌注过程.研究表明缺血预处理对小肠缺血/再灌注损伤具有保护作用,但机制复杂,尚未明确.现就缺血预处理在肠缺血,再灌注损伤中的研究进展作一综述.     

Effects of ischemic preconditioning on myocardial protective on cardiac surgery: possibility of ischemic preconditioning and adenosine administration.

Subject: We evaluated the efficacy for concomitant use of ischemic preconditioning (IPC) and cardioplegic arrest with adenosine premedication on myocardial protection.Methods: Twenty-one pigs were divided into three groups: 1) control group, 2) IPC group which had IPC, 3) IPC+adenosine triphosphate (ATP) group which had an administration of 140 gamma of ATP (Adetphos, Kowa, Tokyo, Japan) during IPC. IPC was employed by 3 minutes of aortic cross clamping and 5 minutes of reperfusion. After cardioplegic arrest, the hemodynamical state was observed during 60 minutes of reperfusion. Serum adenosine, troponin-T, E-max, and Tau (the time constant of early diastolic left ventricular pressure decay) were compared. Results: Serum adenosine levels and at the end of IPC and 60 minutes reperfusion were significantly higher in the IPC and IPC+ATP groups than the control group. Comparison of the myocardial contractile force indicator E-max showed that the IPC and IPC+ATP groups showed significantly higher recovery rates of myocardial contractile force than the control group. Tau was the lowest in the IPC+ATP group than the other groups. In the histopathological study, the control group showed widely distributed hypercontraction bands and waving degeneration of myofibrils. On the other hand, the structure of myofibrils was well preserved in the IPC and IPC+ATP groups.Conclusions: The concomitant use of IPC enhanced the effect of a myocardial protective solution. However, the administration of adenosine during IPC did not show any further advantage than IPC along. (Ann Thorac Cardiovasc Surg 2003; 9: 307-13)     

阿霉素预处理替代缺血预处理提供鼠肝缺血耐受力的实验研究

目的 探讨缺血预处理（IPC）延迟保护作用的发生机制以及应用阿霉素预处理（DPC）是否可以模拟IPC的延迟保护作用。方法 建立大鼠部分肝脏热缺血再灌注模型。IPC组采用肝脏缺血10min，再灌注10in，DPC组经静脉注射阿霉素（1mg/kg体重），对照组等量生理盐水注射。肝组织HSP70和HO－1蛋白和血清TNF－α、IL－10浓度分别采用Western blot法和ELISA法测定。结果 IPC后HO－1和HSP70含量分别于12h和24h达到高峰；IPC和DPC后24h诱导HSP70、HO－1的量无显著差异（P＞0.05）。对照组缺血再灌注后3h血清中TNF－α、AST、ALT、LDH及W／D（湿重／干重）的水平明显升高，而IL－10的含量降低，和假手术组相比差异显著（P＜0.01）；IPC或DPC后降低了TNF－α的释放和AST、ALT、LDH及W／D的水平，提高了IL－10的含量，和对照组相比差异显著（P＜0.01）。结论 IPC的延迟保护作用与HSP70和HO－1的诱导生成有关，DPC可以模拟IPC的延尺性保护作用，诱导HSP70和HO－1的产生。     

Cytokine responses in patients undergoing coronary artery bypass surgery after ischemic preconditioning

OBJECTIVE: The release of proinflammatory cytokines has been shown to be associated with the development of complications after coronary artery bypass grafting with cardiopulmonary bypass. The purpose of the present study was to establish whether ischemic preconditioning (IP) could limit inflammatory cytokines release in patients undergoing elective coronary artery bypass surgery. METHODS: Twenty-two patients with multiple-vessel coronary artery disease and stable angina admitted for first-time elective coronary artery bypass surgery were randomized into control or ischemic preconditioning groups. Patients in the IP group were exposed to two cycles of two-minute myocardial ischemia, followed by three minutes of reperfusion, at the beginning of the revascularization operation, before the cross-clamping and ischemic period used for coronary artery bypass graft anastomosis. Peripheral plasma levels of TNF-alpha, IL-6, IL-8 and IL-10 were measured perioperatively. RESULTS: Significant elevation of IL-6, IL-8 and IL-10 were observed in both groups after reperfusion. Ischemic preconditioning has no effect on cytokine release in the early stage after reperfusion. Arterial blood IL-6 levels in the preconditioning group were significantly lower than in controls at 20 h after declamping (52.93 +/- 9.79 vs 96.04 +/- 17.56 pg/ml, p < 0.05). CONCLUSIONS: The results indicate that ischemic preconditioning results in no effect on systemic inflammatory cytokine release in the early stage but a delayed reduction in IL-6 levels at 20 h after reperfusion.     

缺血预处理抗大鼠肠缺血再灌注肠黏膜损伤的蛋白质组学研究

目的采用蛋白质组研究技术分离、鉴定缺血预处理（IPC）抗大鼠肠缺血再灌注（Ⅱ／R）肠黏膜损伤相关蛋白,探讨其肠保护分子机制。方法将16只SD大鼠,随机分为Ⅱ／R组和IPC组。Ⅱ／R组阻断肠系膜上动脉60min后再开放60min;IPC组在阻断肠系膜上动脉前先阻断20min后再开放5min。余同Ⅱ／R组。再灌注结束即刻刮取肠黏膜,利用高分辨双向电泳对肠黏膜组织进行蛋白质分离．Image Master 2D Elite 5．0图像软件进行分析。应用基质辅助电离解析飞行时间质谱获取肽质量指纹图谱．检索数据库鉴定表达差异的蛋白质,明确其生物学功能。结果双向电泳发现,Ⅱ／R组及IPC组分别有蛋白质点（1404±20）个和（1338±20）个。10个点进行质谱分析,8个蛋白质点经过检索与已知蛋白质匹配．这些蛋白功能涉及到抗氧化、抑制凋亡及改善能量代谢。RT-PCR分析提示IPC上调醛糖还原酶的表达。Western blot分析提示IPC上调醛脱氢酶的表达。结论比较蛋白组学研究揭示IPC对肠缺血再灌注损伤的保护机制可能与其上调了一些具有抗氧化、抑制细胞凋亡及改善能量代谢作用的蛋白有关。     

远端缺血预处理在婴幼儿心脏外科手术中的心肺保护作用

目的 观察远端缺血预处理对婴幼儿心肺功能的保护作用.方法 将48例先天性心脏病患儿随机分为远端缺血预处理组(RIPC组)和对照组.分别在麻醉诱导后,超滤结束时,ICU1、3、6、12、24 h采集血标本,测定肌钙蛋白I(cTnI)浓度,记录动脉血氧分压、气道阻力、氧和指数、肺顺应性.结果 术后RIPC组血清cTnI升高水平低于对照组,但差异无统计学意义(P＞0.05),RIPC组ICU 3 h血清cTnI水平显著低于对照组(10.8±8.5比16.3±15.9,P＜0.01).ICU时间RIPC组高于对照组[(4±2)d比(3±1)d,P＜0.05).结论 远端缺血预处理对心肌的缺血再灌注损伤有保护作用,对肺功能未产生有利影响.

Abstract：

Objective To investigate the protective effect of remote ischemic preconditioning (RIPC) on infants subject to cardiac surgery. Methods Forty-eighty infants were randomized into two groups: RIPC group ( n = 24) and control group ( n = 24). Blood samples were taken after the induction of anesthesia, at the end of ultrafiltration, and at 1,3, 6, 12 and 24 h after ICU arrival for determination of plasma cardiac troponin I (cTnI) concentrations. The pulmonary functional data including artery blood oxygen pressure (PaO2), airway resistance, oxygenation index (OI) and pulmonary compliance were recorded. Results Levels of plasma cTnI were lower in RIPC group than in control group, but there was no significant difference ( P ＞ 0. 05). Levels of plasma cTnI at 3 h after ICU arrival in RIPC group were markedly lower than in control group ( 10. 8 ± 8.5 vs. 16. 3 ± 15.9,P ＜ 0. 01 ). The ICU time in RIPC group was significantly longer than in control group[(4 ± 2) days vs. (3 ± 1 ) days,P ＜ 0. 05 )]. Conclusion RIPC appears to protect the heart against ischemia-reperfusion injury, but can not improve the pulmonary function or the postoperative clinical course in the settings of cardiac surgery of infants.