远隔处理——来自心脏之外的内源性心肌保护作用

Remote preconditioning, endogenous cardioprotection from outside the heart

背景虽然缺血预处理（ischemiapreconditioning，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（remoteischemicpreconditioning，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。

Background Direct ischemia preconditioning （IPC） is the most powerful endogenous eardioprotective 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 myocardial 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.