International Circulation: Could you please discuss some of the new myocardial protection therapies for treatment of acute myocardial infarction.
《国际循环》：能否介绍下急性心梗的新型心肌保护治疗手段？
Heusch: From the experimental side， we have learned over the last 25 years that there are a number of mechanical interventions that can actually protect the myocardium， which are pre-， post-， and remote conditioning. All contain a brief period of ischemia and reperfusion in conjunction with the culprit infarction. Pre-conditioning is a protocol of brief cycles of myocardial ischemia/reperfusion to precede the culprit infarction， post-conditioning is a similar protocol immediately at reperfusion following the culprit infarction， and remote is a protocol of ischemia/reperfusion cycles in a distant organ away from the heart itself. It can be the arm， the liver， the kidney， etc. All of these interventions actually protect the myocardium in the sense that， eventually， the resulting infarction is reduced. Now what can we use for the patient? The problem with pre-conditioning is that you cannot know when a patient undergoes an infarction， so it can only be utilized in elective interventions. For instance， if you plan an intervention such as cardiac surgery， you can utilize pre-conditioning to attenuate the eventual damage.
Heusch教授：在过去的20年中，通过基础研究我们了解到有一些机械干预手段实际上能够保护心肌，即缺血预适应、缺血后处理和远隔预适应，三者都包括罪犯血管短暂的缺血和再灌注。因此预适应是在罪犯血管闭塞之前短暂的心肌缺血再灌注的循环，而缺血后处理则是在罪犯血管闭塞之后，远隔预适应则是在心脏以外远隔器官的缺血再灌注循环。可以是双臂、肝脏和肾脏等。这些干预手段实际上能够保护心肌，最终缩小梗死体积。哪些可以用在患者身上呢？缺血预适应有一个问题，就是你不知道患者何时会发生心梗，因此只能用在择期PCI的情况下。例如计划心脏外科手术等干预时可以利用缺血预适应来减少最终的损害。
International Circulation: How far in advance would the pre-conditioning need to be?
《国际循环》：预适应的时机是什么？
Heusch: There are two time windows. One is one or two hours before the culprit infarction， which is acute pre-conditioning， and the other is later， weaker， but more sustained pre-conditioning， at 24 hours before the culprit infarction. I think， of more practical relevance is post-conditioning， considering you do not know when you will undergo an infarction. The patient who comes in with an infarction can still undergo post-conditioning. Once the artery has been opened， you can use a few cycles of ischemia and reperfusion， called a “stuttering reperfusion.” This will attenuate the resulting infarct which is quite useful. Most proof of concept studies have shown that this is effective. Also， remote conditioning， which is done by inflating a blood pressure cuff around the arms several cycles， will eventually protect the myocardium and reduce infarction.
Heusch教授：有两个时间窗。一个是在干预之前1~2小时，即急性预适应。另一个是在干预之前24小时，虽然作用弱一些，但是作用更为持久。我想更为实用的是缺血后处理，因为我们不知道患者何时会发生心梗。已经发生心梗的患者还可以接受缺血后处理。至少在动脉一旦开通时，可以进行几个缺血再灌注循环，也就是所谓的“stuttering reperfusion”。这有助于缩小梗死体积，很有帮助，众多研究证实了它的有效性。远隔预适应即在手臂用袖带进行充气放气几个循环，最终有助于保护心肌和缩小梗死体积。
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