Konditionierung von Isch?mie/Reperfusion-Ph?nomenen

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• 作者：F. Simon (1)
  E. J?ger (1)
  P. Radermacher (2)
  E. Calzia (2)
  U.B. Brückner (3)
  M. Thiere (1)
  A. Oberhuber (1)
  J. Kick (1)
  K.H. Orend (1)
  L. Sunder-Plassmann (1)
  Prof. Dr. H. Schelzig (1)
  
• 关键词：Rekonstruktion ; Thorakoabdominelle Aorta ; Isch?mie ; Reperfusionsph?nomene ; Reconstruction ; Thoraco ; abdominal section of the aorta ; Ischemia ; Reperfusion phenomena
• 刊名：Gef?sschirurgie
• 出版年：2009
• 出版时间：February 2009
• 年：2009
• 卷：14
• 期：1
• 页码：16-23
• 全文大小：546KB
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• 作者单位：F. Simon (1)
  E. J?ger (1)
  P. Radermacher (2)
  E. Calzia (2)
  U.B. Brückner (3)
  M. Thiere (1)
  A. Oberhuber (1)
  J. Kick (1)
  K.H. Orend (1)
  L. Sunder-Plassmann (1)
  Prof. Dr. H. Schelzig (1)
  
  1. Klinik für Thorax- und Gef??chirurgie, Universit?t Ulm, Stein?velstr. 9, 89075, Ulm, Deutschland
  2. Sektion An?sthesiologische Pathophysiologie und Verfahrensentwicklung, Universit?t Ulm, Ulm, Deutschland
  3. Sektion Chirurgische Forschung, Universit?t Ulm, Ulm, Deutschland
  

文摘

Reconstructions in the thoraco-abdominal section of the aorta are nearly always accompanied by accentuated ischemia and reperfusion sequences to varying degrees. The consequences are at best a temporary functional disturbance of the affected section. The normal clinical result of these extensive operations is induction of systemic inflammation, which in extreme cases can result in permanent loss of function of one or more organs. In addition to individual-specific conditions the extent of this sequence is highly time-dependent. The most sensitive organs from a clinical point of view seem to be neurons and renal tubules. These relationships have led to very different operative measures. The basic strategy is either to avoid ischemia/reperfusion (e.g. arterio-arterial shunt, extracorporeal circulation) or to shorten (e.g. branched stent graft, hybrid procedures, vortex, clamp repair with sequential clamping). If only the articles in German from the last two congresses on vascular surgery in Bern 2007 and Dresden 2008 are taken into consideration, the approaches of the individual hospitals could not be more inconsistent. This low level of standardization possibly indicates that the problem is too multifactorial and/or that essential aspects of the pathophysiology have not been sufficiently considered. Tissue hypoxia and loss of function are classical consequences of various forms of shock (e.g. multiple trauma, septic shock, hemorrhaging). The deciding difference to an ischemia/reperfusion sequence in vascular surgery is, however, that the trigger moment in time can be exactly determined. From this the possibility arises to intervene in this event if its course has been comprehended. Without this concept of conditioning modern transplantation medicine would not be possible. In this situation the therapeutic influence on ischemia/reperfusion phenomena is of pivotal significance. Treatment of diseases of the aorta is an interdisciplinary challenge. For this reason a working group of anesthetists and vascular surgeons was founded at the University of Ulm in 1999 in order to systematically carry out research on the pathophysiology and therapy of ischemia/reperfusion phenomena. This article presents part of the work already achieved to allow a perspective on future projects.