远端缺血预处理的心肌保护作用及其临床应用面临的挑战

Cardioprotective effects of remote ischemic preconditioning and its challenges in clinical application

远端缺血预处理(remote ischemic preconditioning,RIPC)是近几年提出的新型预防性治疗手段,是一种非侵入性和临床相关性的心肌保护策略,即术前给予肢体远端一定时间的急性间歇性缺血,可能减少远端器官(包括心脏、脑等)发生缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)。大量的动物实验和人体临床试验研究发现,RIPC可减少心肌梗死发生率,具有预防心肌I/RI的作用,但从实验转化到临床应用并获利于患者却非常困难。关于RIPC的研究与探索仍在继续,RIPC是否有临床应用的未来?这种治疗是否存在可行性?文章对近几年RIPC心肌保护效应研究的结果进行分析,总结RIPC应用于临床实践的困难所在。

Remote ischemic preconditioning(RIPC)is a novel preventative treatment approach that is proposed in recent years.It is a non‑invasive and clinically relevant preventative strategy of cardiac muscles,that is,to carry out acute transient ischemia in the distant limb before surgery,so as to possibly relieve ischemia/perfusion injury(I/RI)in distant organs(including the heart and brain,etc.).A large number of animal studies and human clinical trials have demonstrated that remote ischemic preconditioning can reduce myocardial infarction size to prevent reperfusion injury.Unfortunately,it is difficult to transform from experiments to clinical application and finally benefit patients.Therefore,the efficient and effective method has yet to be developed.In this review,now analyzed the studies concerning cardioprotective effects by RIPC and summarized the difficulties of clinical practice.