DOI: https://doi.org/10.14739/2310-1210.2019.4.173356

Возможности фармакологической защиты миокарда при синдроме ишемии-реперфузии в эксперименте и клинической практике

S. M. Kozhukhov, O. M. Parkhomenko

Аннотация


 

Ранняя реперфузия инфаркт-зависимой коронарной артерии способствует ограничению зоны некроза, улучшает насосную функцию сердца и положительно влияет на исход заболевания. Внедрение фармакологической и механической реперфузии (тромболитической терапии и перкутанных вмешательств) в клиническую практику значительно улучшило лечение пациентов с острым инфарктом миокарда. Однако эта терапия часто осложняется реперфузионным повреждением (феномен no reflow), которое в дополнение к значительной гибели кардиомиоцитов включает желудочковые нарушения ритма сердца, оглушение миокарда, микрососудистую дисфункцию, а также другими нарушениями. Наиболее важные составляющие реперфузионного повреждения: избыточная продукция реактивных форм кислорода, внутриклеточная перегрузка кальцием, воспалительная клеточная инфильтрация и др. Некоторые из этих механизмов взаимосвязаны. Исходя из этой концепции, существуют теоретические предпосылки использования фармакологических вмешательств для предупреждения осложнений реперфузии. Эту гипотезу в основном изучали в экспериментальных исследованиях, получены убедительные данные по защите миокарда.

Цель работы – рассмотреть различные фармакологические вмешательства для лечения реперфузионного повреждения миокарда, включая антиоксидантные флавоноиды, терапию глюкозо – инсулин – калиевой смесью, аденозином, мелатонином, метопрололом, никорандилом, фосфокреатином, триметазидином, циклоспорином А и др.

Выводы. Влияя на процессы, связанные с реперфузионным повреждением, можно улучшить результаты лечения инфаркта миокарда. К сожалению, до сих пор эта цель не достигнута в реальной клинической практике. Тем не менее, при изучении в экспериментальных и клинических исследованиях новых молекул получены важные данные, которые могут быть положены в основу новых исследований и внедрение кардиопротекции в клиническую практику.


Ключевые слова


инфаркт миокарда; реперфузияж фармакологические вмешательства

Полный текст:

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Литература


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