(Ischemia-reperfusion injury, IRI )

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??-????? (Ischemia-reperfusion injury, IRI )
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Case study
???,58?,??8?,???????,30min???
????????,9??????? ????75/50mmHg,????,??65?/min,??
? ????????????? ?????????????85??,?
?78??? ?????????????????????????
????????10?????????10.30???
?????????(??),??????,??
?13??????????????,??6????
?16?,???????????????????
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????(Conception) ???????????????????
????? ?????,??????????????????
Usually blood reperfusion should reduce
the ischemia injury. However, recent clinical
observations and animal ex- periments showed that
blood reperfusion sometimes indu- ces or
aggravates the further reversible even
irreversible cell damage, especially for a
prolonged ischemia.
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?? ?????( Etiology Factors)
1.??(Etiology) ??(Ischemia) (Myocardial
infarction,cardiac bypass surgery, shock, organ
transplantation, thrombolytic therapy,PTCA, etc)
2.??(Factors) ???????(Duration of
ischemia) ?????????(Collateral
circulation) ??????(Dependency on oxygen)
??????(Condition of reperfusion)
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??
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?????????(Increase free radical) 1.
?????(Conception and classification) ??(Conceptio
n) ?????????????????????????
(Free radical are a highly reactive group of
atoms, molecules or radicals, which carry
unpaired electron in outer orbital. )
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?????(Oxygen free radical,OFR)
???????????????? (??????????????,Oxygen-derived
free radical )
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???????(Reactive nitrogen species, RNS)
????,??????????????????? ????????????

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2. ??????( Property of free radical) ??????????
???????
3. ??????(Scavenge the free radicals)
?????(Enzymes)
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4. ???????(Mechanism of free radical increase)
One electron deoxidize increase in
mitochondria
?
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Increase xanthine oxidase (XO) in VEC
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Neutrophils respiratory burst ???PMN???????,??O2?
7090?NADPH oxidase?NADH oxidase? ???,??????OFR
? ??? ???PMN??? OFR?(respiratory burst)
??????????
??-?????
?????(??)
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???Ca2??(Ca2 overload)
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???????? ????(ROS)????? ????????
???????????? ??PLA2
PG?TXA2?LT?, ???????
????????? ??NF-?B
????????? ???WBC
?????
PLA2 ???A2?LT???
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?????(Calcium overload) ?Concept?
???????????????????????? ??????????
2.Ca2??????? Ca2??Na-Ca2???Ca2-H???
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4.?????????????
5.????
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???????? ????????(angiotension ?)???
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??? ??????-?????
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?????(Change of ECG ) ???ST???,R?????? ??????R?
??????,ST?????????,
Q?????,?????????????
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(?)?????? (Heart functional changes) ?????????????
(????) ????(Myocardial stunning) ?????????????,??
?????????? ???,????????????????????
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(?)???????? (Alterations of myocardium
ultrastructure) ??????????????????????????
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? ??????????????
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?????-????? (Ischemia-reperfusion injury to
brain)
??????
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?????VEC??,???????????????,??????
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?????(Reactive oxygen species, ROS)
????,??????????????????? ????????
ROS??(Classofication of ROS)
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??? 1.????????-???????????? 2.????????????????????
?????? 3.????-??????XO?????????????? 4.???????????
-?????????? 5. ???????????????????? 6.
??????????????????????? 7. ???????????????