虽然缺血预处理（IPC）仍然是目前已知的最强大内源性心肌保护措施，但是因时机选择等原因其临床应用受到了限制。研究表明，其他器官或组织经历短暂缺血后可使心肌对后继的长时间缺血更加耐受，即远隔缺血预处理（RIPC）的保护作用。目前的研究已经将远隔处理的保护作用从单一的心肌保护领域扩展到了对全身众多器官或组织的保护作用中。已有少数随机对照临床研究证实了肢体远隔缺血后处理（RIPOC）的心肌保护作用。然而，在将远隔处理推荐作为临床工作的常规措施之前，仍需进行更多大规模的临床研究以评估和优化远隔处理措施的保护作用。本文就远隔处理的发现发展，心肌保护作用机制及其临床应用价值进行了综述。
Direct ischemia preconditioning (IPC) is the most powerful endogenous cardioprotective intervention up to now. But its clinical application has been hampered by the requirement to intervene before the onset of acute myocardial ischemia. Experimental data suggest that remote ischemic preconditioning (RIPC), where brief ischemia in one remote organ or tissue confers resistance to subsequent sustained ischemic insults in another tissue. The concept of remote organ protection has now been extended beyond that of solely protecting the heart to providing a general form of inter-organ protection against ischemia reperfusion injury. Small randomized trials in humans undergoing PCI or major surgery suggest that RIPC induced by brief limb ischemia significantly reduces myocardial injury. However, large-scale clinical trials to assess and optimize the effect of remote conditioning on mortality and morbidity are required before it can be recommended for routine clinical use. This article reviews the history and evolution of the remote conditioning, the potential mechanistic pathways underlying its cardioprotective effect, and its emerging application in the clinical setting.
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