【摘要】 目的:缺血后适应即冠状动脉再灌注开始时对冠脉进行短暂、重复的开通及再闭过程,随后恢复冠状动脉血流,对缺血再灌注心脏有显著保护作用。总结并分析缺血后适应对缺血再灌注心脏的保护作用及其机制。资料来源:应用计算机检索Medline1986-01/2006-05关于缺血后适应的文章。检索词“myocardial protection,Ischemic postconditioning,Ischemia-reperfusion injury”并限定文章的语种类为English。资料选择:对资料进行初审,纳入标准:关于缺血后适应机制及心脏保护作用的研究。排除标准:重复性研究。资料提炼:共收集到符合上述要求的文献51篇,排除21篇重复性研究。30篇符合纳入标准:其中26篇关于缺血后适应的研究,4篇关于缺血后适应的综述。资料综合:缺血后适应对心脏的保护作用包括缩小心肌梗死面积、对抗心律失常等。缺血后适应对心脏的保护作用的机制涉及腺苷、一氧化氮、线粒体ATP敏感K通道、再灌注损伤存活激酶通路、线粒体可渗透转运孔隙等许多方面和信号传导途径。结论:缺血后适应现象已经被许多独立的实验室应用大、小动物在体和体外模型及细胞培养模型所观察。与缺血预适应相比,缺血后适应可能会有更广阔的临床应用前景,其机制需进一步研究。更多还原

【Abstract】 OBJECTIVE: Multiple, short, regional coronary occlusions immediately after prolonged myocardial ischemia can effectively protect the myocardium, which is named ischemic postconditioning. To review and analyze the protective effect and the mechanism of ischemic postconditioning on ischemic reperfusion myocardium. DATA SOURCES: A computer-based search was conducted in Medline for articles about ischemic postconditioning published between January 1986 and May 2006 with the Keyword of "myocardial protection, Ischemic postconditioning, Ischemia-reperfusion injury", and the language was limited to English. STUDY SELECTION: Data were checked in the first trial. Inclusion criteria: Researches about the mechanism of ischemic postconditioning and myocardial prevention. Exclusion criteria: Repetitive studies. DATA EXTRACTION: There were 51 literatures in accordance with the criteria, and 21 of them were excluded due to the repetition of the same research. Among 30 enrolled literatures, 26 researches were about ischemic postconditioning and 4 reviews related to the ischemic postconditioning. DATA SYNTHESIS: The myocardial prevention of ischemic postconditioning included decreasing of the infarct size and terminating of the reperfusion arrhythmias. The mechanism of cardio-protection by ischemic postconditioning was related to adenosine, nitric oxide, KATP, pathway of living kinase injured by reperfusion, permeable transporting ventage of bioblast and some other signaling pathways. CONCLUSION: The postconditioning phenomenon has been applied by a number of independent laboratories on large and small animal models in vivo and in vitro for observation. In contrast to ischemic preconditioning, ischemic postconditioning may have a extensive clinical application, while more work must be done to further probe into its mechanism.更多还原