体外循环后的炎症反应和内皮功能障碍:病理生理学和药理学靶点。

IF 4.2 Q3 Pharmacology, Toxicology and Pharmaceutics
O. Giacinto, U. Satriano, A. Nenna, C. Spadaccio, M. Lusini, C. Mastroianni, F. Nappi, M. Chello
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引用次数: 56

摘要

背景:体外循环过程中发生的血管内皮损伤是器官功能障碍的一个重要因素,器官功能障碍导致心脏手术过程中出现许多术后并发症。目的综述体外循环相关疾病的主要机制,评价导致组织损伤的不良事件,并介绍目前体外循环相关损伤的药物和非药物机制。方法采用Medline/Pubmed/Scopus检索,检索关键词为“心脏外科”、“体外循环”、“炎症”和“内皮损伤”,以及相关MeSH术语,截止到2019年7月。检索策略包括荟萃分析、随机对照试验、临床试验、综述和相关参考文献。使用相同的关键词从https://patents.google.com/、www.uspto.gov和www.freepatentsonline.com.RESULTSIn检索专利。本文综述了血管内皮细胞损伤机制、急性炎症反应和体外循环过程中控制血管损伤程度的调节因子的最新知识,总结了抗炎药物和非药物策略的主要目标。结论体外循环术后的炎症反应和内皮功能障碍是心脏外科手术带来益处的代价。消除体外循环的不利影响似乎是改善儿科和成人心脏手术临床结果的关键。内在的复杂性和相关因素的紧密相互作用可能需要一个整体的方法来对抗炎症和内皮反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inflammatory Response and Endothelial Dysfunction Following Cardiopulmonary Bypass: Pathophysiology and Pharmacological Targets.
BACKGROUND Endothelial injury occurring during cardiopulmonary bypass is a major contributing factor in the development of organ dysfunction, which leads to many of the postoperative complications occurring during cardiac surgery. OBJECTIVE This narrative review aims to summarize the main mechanisms of cardiopulmonary bypass - related disease, evaluating the unfavorable events leading to tissue injury, with a description of current pharmacologic and non-pharmacologic mechanisms to reduce CPB-related injury. METHODS A Medline/Pubmed/Scopus search was conducted using clinical queries with the key terms "cardiac surgery", "cardiopulmonary bypass", "inflammation" and "endothelial injury", and related MeSH terms, until July 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the same key terms from https://patents.google.com/, www.uspto.gov, and www.freepatentsonline.com. RESULTS In this review we discuss the current knowledge of the mechanisms of vascular endothelial cell injury, the acute inflammatory response, and the regulatory factors that control the extent of vascular injury during extracorporeal circulation, summarizing the main target of anti-inflammatory pharmacologic and non-pharmacologic strategies. CONCLUSION Inflammatory response and endothelial dysfunction following cardiopulmonary bypass are the price to pay for the benefits offered during cardiac surgery procedures. Counteracting the detrimental effect of extracorporeal circulation appears to be crucial to improve clinical outcomes in pediatric and adult cardiac surgery. The intrinsic complexity and the tight interplay of the factors involved might require a holistic approach against inflammation and endothelial response.
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来源期刊
CiteScore
3.90
自引率
0.00%
发文量
0
期刊介绍: Recent Patents on Inflammation & Allergy Drug Discovery publishes review articles by experts on recent patents in the field of inflammation and allergy drug discovery e.g. on novel bioactive compounds, analogs and targets. A selection of important and recent patents in the field is also included in the journal. The journal is essential reading for all researchers involved in inflammation and allergy drug design and discovery.
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