作　　者： (汪永生）; (王连生）;

机构地区： 南京医科大学第一附属医院心血管内科,江苏南京210029

出　　处： 《中国急救医学》 2017年第9期855-859,共5页

摘　　要： 早期成功的心肌再灌注是治疗急性心肌梗死（AMI）的重要策略，但缺血／再灌注损伤会导致心肌损害进一步加重。治疗性低温（TH）32～34℃可以减轻AMI动物模型的再灌注损伤、预防无复流的发生并能改善心肌梗死后的心室重构。然而，多数随机对照临床试验结果表明，治疗性低温未能使AMI患者获益，但在大面积心肌梗死和再灌注前快速达到靶温度的患者中，低温干预是能获益的，未来包括局部心肌低温治疗和院前降温处理在内的新的低温策略可能会使AMI患者获益更多。 Early and successful restoration of myocardial perfusion is the most effective strategy to reduce infarct size and improve clinical outcomes in patients with acute myocardial infarction （AMI）. But, reperfusion itself causes myocardial damage by ischemia/reperfusion injury as well. Data of experiments have shown that therapeutic hypothermia （TH） 32 -34℃ could attenuate the reperfusion injury, prevent no - flow and improve ventricular remodeling in AMI models. However, inconsistent with those animal experiments, most clinical trials did not attain the same beneficial effects from TH in patients with AMI. Most recent meta - analysis reported that the benefit of TH still be observed in large infarct patients cooled rapidly before reperfusion. Novel strategies, including local induction of myoeardium hypothermia and pre -hospital cooling, might be more beneficial in future.

关 键 词： 治疗性低温 急性心肌梗死 缺血 再灌注损伤 心脏保护