缺血再灌注损伤（IschemiareperfusioninjuryIRI）课件

1、缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）患者：男，58岁，上午8时，起床后感到胸闷，30min后突感 心胸前区剧烈绞痛，9时入急诊病房。体查：血压75/50mmHg，意识淡漠，心率65次/min，律齐。 心电图示度房室传导阻滞。冠状动脉造影：右冠状动脉上段85%狭窄，中段78%狭窄。入院治疗：立即给予阿托品、多巴胺、低分子右旋糖酐等进 行扩冠治疗。上午10时静脉点滴尿激酶。10.30分患者 出现阵发性心室颤动（室颤），立即给予除颤，到下 午13时反复发生室性心动过速、室颤，共计6次。到下

2、 午16时，经给予利多卡因、小剂量异丙肾上腺素后心 律转为窦性，血压平稳，意识清楚。缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI） Usually blood reperfusion should reduce the ischemia injury. However, recent clinical observations and animal ex- periments showed that blood repe

3、rfusion sometimes indu- ces or aggravates the further reversible even irreversible cell damage, especially for a prolonged ischemia. 缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）内皮素的作用 高能磷酸化合物缺乏 The increase free radicals, calcium ove

4、rload, neutrophils activation, play the principal roles in ischemia-reperfusion injury.缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）O2 （O缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI） 缺血再灌注损伤（IschemiareperfusioninjuryIRI）Ca2+超载缺血再灌注损伤（Ischemia

5、reperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）MPO：过氧化物酶缺血再灌注损伤（IschemiareperfusioninjuryIRI） 缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）：磷脂酶A 、LT：白三烯 缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（Ischemiareperfusioninjury

6、IRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI） The ischemia region could not be reperfused sufficiently after relieving the occlusion to recover the blood fl

7、ow.缺血再灌注损伤（IschemiareperfusioninjuryIRI）O2 炎症介质炎症介质缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）The energy metabolism mainl

8、y focus on the generation and utilization of ATP in myocardium. In normally the ischemic injury should relieve after reperfusion recover. It is revealed that the high-energy phosphates stored in heart do not increase followed by reperfusion, instead of deplete further. That means the generation of A

9、TP is lower because the mitochondria damaged by oxygen free radicals and calcium overload. 缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI）O2O2 eO2 OH + H2O 3e3H+2eO2 H2O2 2H+4eO2 2H2O4H+2 缺血再灌注损伤（Isc

10、hemiareperfusioninjuryIRI）缺血再灌注损伤（IschemiareperfusioninjuryIRI） Reactive oxygen species (ROS) are composed by oxygen-derived free radicals (OFR) and non free radical substances, such as superoxide anion radical ( ), hydroxyl radical (), hydrogen peroxide () and singlet oxygen (1O2).2 ROSH2O2, 1O2, O

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