血透患者远程缺血预处理的心肌保护作用
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Remote ischemic preconditioning in myocardial protection in hemodialysis patients
背景
远程缺血预处理（RIPC）是一种短暂缺血再灌注过程。血透期间RIPC的心肌保护作用尚未确认。这项研究的目的是通过在门诊透析病人中测量超敏肌钙蛋白，来评估远程缺血预处理对心肌的保护作用。
方 法
随机双盲试验分为RIPC干预组与对照组。干预组在三次连续血透期间接受了RIPC。在每个期间前后采集血样。测量血液尿素氮计算单室模型尿素清除指数和超敏肌钙蛋白I，以评估透析充分性和心肌损伤。
结 果
总共47名患者被随机分配。约60.8%为男性，54%为糖尿病。干预组单室模型尿素清除指数为1.51，对照组为1.49.在透析前后：超敏肌钙蛋白I从采集时间开始测量无显著变化。
结 论
连续三次血透间期的RICP干预并没有证明优于对照。而另一项研究连续12次测试了RICP的血透结果，表明心肌保护作用良好。在我们的研究中，超过一半的患者是糖尿病患者。由于冠脉循环旁路较多，糖尿病患者对RIPC的反应较低。总而言之，在该模型中，RIPC对超敏肌钙蛋白I没有影响，但在所有测试模型中，肌钙蛋白对心肌梗塞具有很高的负面预测价值。
原始文献摘要
Background: Remote ischemic preconditioning (RIPC) is a procedure that generates a brief period of ischemia followed by reperfusion. The role of RIPC in protecting myocardial ischemia during hemodialysis is not yet established. The aim of the study was to evaluate RIPC myocardial protection as evaluated by ultrasensitive I troponin in hemodialysis outpatients.
Patients and methods: A double-blind randomized trial with two groups: intervention sub-mitted to RIPC and control group without RIPC. Intervention group received RIPC in three consecutive hemodialysis sessions. Blood samples were taken before and after each session. Blood urea nitrogen for calculation of single-pool Kt/v and ultrasensitive I troponin were measured to evaluate dialysis adequacy and myocardial injury.
Results: A total of 47 patients were randomized. About 60.8% were men and 54% were diabetic. The mean single-pool Kt/v was 1.51 in the intervention group and 1.49 in control. The ultrasensitive troponin I measured no significant change from the time of collection: before or after dialysis.
Conclusion: The RIPC applied in three consecutive sessions did not demonstrate superiority to control, therefore another study tested RIPC in 12 consecutive sessions with a positive result in myocardial protection. In our study, more than half of the patients were diabetic. Diabetic patients have a trend to show a lower response to RIPC because of the greater presence of collateral coronary circulation. In summary, in this model there was no interference of RIPC in ultrasensitive troponin I values, but troponin had a high negative predictive value for myocardial infarction in all tested models.
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