缺血預處理對器官保護作用的文獻分析_《中國循證醫學雜志》

作者：

甄子朋 ¹ , 黃玉川 ¹ ,  李幼平 ^1,2

1. 四川大學華西醫院衛生部移植工程與移植免疫重點實驗室（成都 610041）；3. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

缺血預處理文獻評價缺血再灌注損傷器官保護外科手術移植

DOI：

10.7507/1672-2531.20100386

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　對國內外公開發表的有關缺血預處理（ischemic preconditioning，IPC）對器官保護作用的基礎與臨床研究文獻進行統計與分析，了解IPC 的歷史沿革、臨床和基礎研究進展，探索器官移植中IPC 的作用和機制。
方法　計算機檢索MEDLINE（1966 ～ 2009.8）、EMbase（1974 ～ 2009.8）和Cochrane Library（2009 年第2 期），由兩名研究者獨立篩選研究IPC 的文獻，進行分類整理和分析。
結果　最終納入1 398 篇文獻，其中75% 為基礎研究，臨床研究僅占25%；研究的靶器官73% 是心臟和肝臟。近年有關IPC 對心臟、腦、脊髓和肝臟干預效應的研究明顯增加，但關于IPC 干預在心臟和肝外科及移植手術的臨床研究則明顯滯后于基礎研究；IPC 對其他器官如腎臟、肺、胃腸及胰腺效應的臨床研究也相對較少。
結論　 IPC 對心臟外科及移植相關手術、肝外科手術及活體肝移植、肺普通手術及移植相關手術均有保護效果；IPC 可有效減輕中樞神經系統缺血再灌注損傷的程度，但對尸肝移植無保護效果；IPC 對腎臟、胃腸道的效應尚不明確。IPC 干預對器官的保護效應機制尚無結論。

引用本文： 甄子朋,黃玉川,李幼平. 缺血預處理對器官保護作用的文獻分析. 中國循證醫學雜志, 2010, 10(2): 203-214. doi: 10.7507/1672-2531.20100386 復制

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2. Goode HF, Webster NR, Howdle PD, et al. Reperfusion injury, antioxidants and hemodynamics during orthotopic liver transplanta tion. Hepatology, 1994, 19(2): 354-359.
3. Langle F, Roth E, Steininger R, et al. Arginase release following liver reperfusion. Evidence of hemodynamic action of arginase infusions. Transplantation, 1995, 59(11): 1542-1549.
4. Gerlach J, Jorres A, Schon M, et al. Systemic liberation of interleukin-.
5. trial. J Thromb Thrombolysis, 1998, 6(2): 89-92.
6. Clavien PA, Camargo CA, Gorczynski R, et al. Acute reactant cytokines and neutrophil adhesion after warm ischemia in cirrhotic and noncirrhotic human livers. Hepatology, 1996, 23(6): 1456-1463.
7. Lentsch AB, Yoshidome H, Cheadle WG, et al. Chemokine involvement in hepatic ischemia/reperfusion injury in mice: Roles for macrophage inflammatory protein-2 and KC. Hepatology, 1998, 27(2): 507-512.
8. Colletti LM, Kunkel SL, Walz A, et al. Chemokine expression during hepatic ischemia/ reperfusion-induced lung injury in the rat. The role of epithelial neutrophil activating protein. J Clin Invest, 1995, 95(1): 134-142.
9. in the perioperative phase of liver transplantation. Transpl Int, 1997, 10(5): 401-404.
10. Boros P, Tarcsafalvi A, Wang L, et al. Intrahepatic expression and release of vascular endothelial growth factor following orthotopic liver transplantation in the rat. Transplantation, 2001, 72(5): 805-811.
11. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation, 1986, 74(5): 1124-1136.
12. Cohen MV, Baines CP, Downey JM. Ischemic preconditioning: from adenosine receptor to KATP channel. Annu Rev Physiol, 2000, 62: 79-109.
13. Przyklenk K, Bauer B, Ovize M, et al. Regional ischemic ‘preconditioning’ protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation, 1993, 87(3): 893-899.
14. Lazaris AM, Maheras AN, Vasdekis SN, et al. Protective effect of remote ischemic preconditioning in renal ischemia/reperfusion injury, in a model of thoracoabdominal aorta approach. J Surg Res, 2009, 154(2): 267-273.
15. Hausenloy DJ, Mwamure PK, Venugopal V, et al. Effect of remote ischemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet, 2007, 370(9587): 575-579.
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