心肌缺血／再灌注损伤治疗新策略——迷走神经电刺激

A new strategy for the therapy of myocardial ischemia/reperfusion injury electrical stimulation of vagus nerve.

背景虽然缺血预处理（ischemicprecondition，IPC）仍然是目前已知的最强大内源性心肌保护措施，但是因时机选择等原因其临床应用受到了极大的限制。大量动物实验证明，刺激迷走神经能够通过激活“胆碱能抗炎通路”、降低心肌交感神经兴奋性和抑制氧自由基的产生等作用机制，来减轻心肌缺血，再灌注损伤（ischemia／reperfusioninjury，I／RI）。另外，也有少数随机对照临床研究证实了迷走神经刺激的心肌保护作用。目的评价迷走神经刺激对心肌I／RI的保护作用。内容包括迷走神经刺激的发现、发展，心肌保护作用的机制及其临床应用价值。趋向这一现象的发现为降低心肌I／RI提供了一个简单易行且费用低廉的措施。然而，在将迷走神经刺激推荐作为临床工作的常规措施之前，仍需进行更多大规模的临床研究，以评估和优化迷走神经刺激措施的保护作用。

Background Ischemic preconditioning（IPC） is the most powerful endogenous cardioprotective intervention up to now, but its clinical application has been hampered due to the requirement to intervene before ischemia insult. Many animal studies suggest that electrical stimulation of vagus nerve can attenuate myocardial ischemi/reperfusion injury （FRI） by activating the cholinergic anti-inflammatory pathway, lowering the excitability of sympathetic nerves and inhibiting the production of oxygen free radicals. In addition, a few randomized controlled clinical trials also identify that electrical stimulation of vagus nerve significantly reduces myocardial injury. Objective To evaluate the protective effect of electrical stimulation of vagus nerve on myocardial I/RI. Content The evolution and development of electrical stimulation of vagus nerve, the potential mechanistic pathways underlying its cardioprotective effect, and its emerging application in clinical setting are in detail introduced. Trend Electrical stimulation of vagus nerve may provide a feasible and inexpensive method to reduce myocardium I/RI. However, large-scale clinical trials to assess and optimize the effect of vagus nerve stimulation on mortality and morbidity are required before it can be recommended for routine clinical use.