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目的:探讨心肌缺血再灌注研究中的一些棘手问题,以及目前应对这些问题的主要临床辅助策略。方法:通过查阅近几年发表的有关心肌缺血再灌注研究的文献,分析该研究领域的研究现状。结果:再灌注是恢复缺血心肌血流供应的有效手段。研究发现,冠状动脉闭塞后60～90 min实施再灌注能够有效挽救缺血心肌。再灌注可以引起心律失常、微循环紊乱、受损心肌细胞死亡,导致再灌注损伤;而不利的心肌重塑则是急性心肌梗死患者主要的死亡原因之一。常规即时再灌注的实施、减轻再灌注损伤和防止不利的心肌重塑等是现在临床治疗面临的难题。采取预处理、活化再灌注损伤救援激酶、干细胞治疗等辅助措施有望解决这些难题。结论:心肌缺血再灌注虽是恢复缺血心肌血液供应最有效的手段之一,然而,再灌注引起的损伤及不利的重塑也是急需解决的难题,再灌注治疗联合辅助措施有望为解决这一问题带来突破。
Objective: To investigate some thorny problems in the research of myocardial ischemia-reperfusion and the main clinical assistant strategies to deal with these problems. Methods: By reviewing the literatures published in recent years about myocardial ischemia-reperfusion, the research status in this field is analyzed. Results: Reperfusion was an effective means of restoring ischemic myocardial blood flow. The study found that 60 ~ 90 min after coronary occlusion reperfusion can effectively save the ischemic myocardium. Reperfusion can cause arrhythmia, microcirculation disturbance, myocardial cell death, resulting in reperfusion injury; and adverse myocardial remodeling is one of the main causes of death in patients with acute myocardial infarction. Routine immediate reperfusion, mitigation of reperfusion injury, and prevention of adverse myocardial remodeling are the challenges in clinical practice. To take pretreatment, activation and reperfusion injury rescue kinases, stem cell therapy and other ancillary measures are expected to solve these problems. Conclusion: Myocardial ischemia-reperfusion is one of the most effective means to restore the blood supply of ischemic myocardium. However, the damage caused by reperfusion and unfavorable remodeling are also urgent problems to be solved. Combined reperfusion therapy is expected to solve this problem A problem to bring about a breakthrough.