Under the definition of reperfusion syndrome understand the condition that occurs after the resumption of normal blood circulation in the area affected by ischemia. Physicians often have to deal with all sorts of manifestations of ischemia in practice. Reduced blood flow can be due to various reasons.
Such a violation can be short-term or long-term, it can cover a small area or affect a large part of the body. This factor determines how successful the recovery will be.
In principle, the reperfusion syndrome can be considered a kind of body response to ischemia of any origin. In medical circles, this condition is also called "turning on." However, the concept of reperfusion cardiac syndrome should be known to the patients themselves. This article was prepared for this.
Reperfusion mechanism
In infarction conditions, due to impaired vascular capacity, there is a lack of supply to the tissues of the heart muscle.
A similar phenomenon occurs with a stroke. As a rule, such violations are the result ofstenosis or the result of thrombus formation. When it is possible to expand the lumen of the artery, the renewed blood supply is not always able to ensure the normal course of metabolic processes. On the contrary, the patient's condition may deteriorate sharply, which is explained by the development of reperfusion syndrome. It is possible to get a patient out of such a grave condition only with the help of immediately started complex intensive care.
A similar clinic can be traced after the removal of sutures if the patient underwent surgery. Compared with prolonged ischemia, a short-term (no more than 3 hours) or partial decrease in blood flow is not accompanied by serious consequences. In such cases, blood circulation usually quickly normalizes, and with it the course of metabolic processes stabilizes.
Prolonged ischemia is dangerous because during the violation, products of improper metabolism accumulate, and when normal blood flow resumes, they are transferred to neighboring areas, causing tissue destruction there.
Reperfusion Clinic
The symptoms of the syndrome are not always the same, because the area affected by ischemia plays a key role. It is necessary to consider the features of the clinic depending on this factor.
Myocardial ischemia
The severity of the clinical picture of reperfusion syndrome in myocardial infarction largely depends on the duration of ischemia. Experts are guided by the following indicators. If such a period leaves up to 20 minutes, then there may be no reperfusion syndrome at all.
Butin a 40-minute state, when normal blood circulation is disturbed, often after the resumption of blood flow, as a result, damage to the heart muscle appears. That is, the syndrome of ischemic and reperfusion injury of the myocardium is a dangerous condition.
Heart attacks
Infarct conditions are characterized by the fact that certain symptoms are often noted at the stage of restoration of blood circulation. Let's list them:
- arrhythmia;
- increasing signs of HF (heart failure);
- BP drops;
- expanding the boundaries of the heart;
- there is a risk of aneurysm formation.
Brain injury
Such phenomena are often observed after traumatic brain injury (TBI). Against the background of relative stabilization of hemodynamics with timely therapy, the patient's condition may suddenly worsen. At the same time, the signs of oppression of consciousness sharply increase in patients.
Resuscitators, together with neurosurgeons, have long been looking for ways to prevent such secondary brain damage, but so far their aspirations have not been successful.
Stroke
With an ischemic stroke, the following symptoms are observed:
- reflexes are broken;
- consciousness is disturbed up to its complete loss;
- speech worsens;
- disorders of motor functions appear;
- increasing signs of cerebral edema;
- may have cramps.
If ischemia is aggravated by hemorrhage, the recovery period, even with intensive care, can take months, and oftenyears.
Lerish Syndrome
This is a rare disease in which part of the aorta in the lower abdominal region loses its capacity, and is characterized by a vivid clinic of the "on" syndrome.
Despite the resumption of peripheral circulation, as evidenced by warmer extremities, patients complain of severe pain in the lumbar region. The picture is complemented by a violation of the heart rhythm. It is not uncommon for these patients to rapidly develop signs of lung damage.
Restoration of blood flow in the limbs
Reperfusion syndrome in this case is usually also accompanied by vivid symptoms. These phenomena are especially acute one day after the treatment started.
If we summarize the above information, we can conclude that the period of resumption of blood circulation in the area with severe tissue damage is usually accompanied by both local and general disorders. For example, during reperfusion of the brain, tissue edema increases, and after surgery on the lower limb, the intensity of pain increases, and trophic disorders are observed.
From the systemic manifestations of the "on" syndrome, special attention should be paid to the development of multiple organ failure - this is the most severe severe reaction of the body. In most clinical cases, there is an increase in the symptoms of ARDS (respiratory distress syndrome), encephalopathy.
In other words, the reperfusion syndrome develops where the episode of ischemia occurred. Moreover, the larger the affected area andthe longer the period of impaired blood flow, the more pronounced the clinical symptoms will be.
Reperfusion reasons
In critical situations, when normal blood flow is disturbed, the tissues receive less oxygen, resulting in hypoxia.
At the basis of the pathogenesis of the "on" syndrome is the so-called "oxygen paradox". Its essence lies in the fact that when normal blood circulation is established after temporary hypoxia, the manifestations caused by a lack of oxygen do not stop, but, on the contrary, manifest themselves as pronouncedly as possible. This is the peculiarity of this phenomenon. That is, with a sharp activation of oxidation processes, the mechanisms for the formation of a large number of free radicals are triggered.
As a result of these processes, the integrity of cell membranes is disrupted, which ultimately leads to massive destruction of the structure of damaged tissues.
The reasons for the decrease in the patency of the vascular bed are most often due to the formation of a blood clot, the appearance of atherosclerotic plaques on the walls, and spasm of the artery. All this leads to circulatory disorders in the main vessels and vessels of the brain, which is accompanied by symptoms characteristic of ischemia.
Restoration of blood flow in such cases may be due to the following factors:
- spontaneous relaxation of vessel walls;
- administration of antispasmodic or painkillers;
- clot dissolution with enzymatic products;
- surgical removal of a blood clot;
- stent placement(special catheter);
- shunting the vessel lumen (creating a bypass route for blood flow);
- spontaneous restoration of blood circulation after surgical removal of a blood clot or when redirecting the blood flow along an alternative path.
As a result of the resumption of blood flow - in the tissues of the brain and heart muscle, there are separate zones that differ in the level of physiological activity and metabolic processes. Moreover, one part of such local areas still does not receive the required volumes of blood due to violations of the patency of small vessels, while accelerated tissue destruction is observed in other areas.
In other words, after the resumption of blood circulation, tissue cells are simply not able, due to previous ischemia, to assimilate the previous volumes of oxygen, fluid, and nutrients. For this reason, there is no energy resource development. As a result, swelling of tissues increases, inflammatory processes develop.
Treatment methods
Therapy for symptoms of reperfusion syndrome is carried out in a complex manner. At the same time, the doctor must take into account all the cornerstones that provoke the development of pathology, namely:
- active formation of free radicals;
- magnesium deficiency;
- excess calcium s alts;
- development of arrhythmia (contributes to reperfusion syndrome in myocardial infarction);
- impaired energy synthesis.
Taking into account the above factors, the following methods are included in the treatment complex.
Correctionelectrolyte dysfunctions
To neutralize the destructive effect of calcium ions, antagonist drugs are used: Norvax, Diacordin, Isoptin.
In stroke conditions, "Cinnarizine" is prescribed. These medicines relieve spasm and reduce the risk of platelet aggregation.
Antioxidant therapy
Aimed at protecting the cellular structures of tissues. The drug "Quercetin" is highly effective. It reduces the activity of platelets, and eliminates the asymmetry of the blood flow.
A positive result is obtained by the use of such means as "Kudesan", "Mexidol".
Stimulation of metabolic processes
Carried out through the use of medications:
- with a heart attack - "Trimetazidine";
- with a stroke - "Ceraxon".
These drugs normalize the flow of electrolytes. They contribute to the formation of full-fledged energy bonds.
In addition, drugs accelerate the course of recovery processes in tissues damaged by ischemia.
Antiarrhythmic therapy
Reduced to the use of such drugs as "Lidocaine", "Kordaron". Such medications reduce the risk of developing ventricular fibrillation with frequent attacks of tachycardia or the appearance of a series of extrasystoles.
If therapy proves unproductive, may be useddefibrillation. To normalize the course of metabolic processes in the heart muscle, "Kurantil", "Magnesium sulfate" are prescribed.
General tonic
Usually also included in the treatment of reperfusion syndrome. They are necessary to restore the protective resources of the patient's body, as well as to replenish the missing useful trace elements in the tissues. As a rule, vitamins of group "B", nicotinic acid (vitamin PP), ascorbic acid are used.
Of course, rehabilitation therapy should be carried out exclusively in a hospital setting. The implementation of the entire complex of therapeutic measures is necessarily controlled by a doctor.
Prevention of reperfusion syndrome
As they say, it is easier to "strangle the disease in its infancy" than to treat it later. Therefore, it is worth thinking about preventive measures. To exclude the development of reperfusion syndrome or to smooth out its negative manifestations, in modern practice, doctors use means that:
- completely eliminate the formation of ROS (reactive oxygen species):
- provide oxygen supply directly to cell structures;
- help restore normal aerobic metabolism;
- allow to protect tissues from re-damage.
By applying effective preventive measures in practice, it is possible to prevent the devastating consequences of secondary tissue damage after severe TBI. If we are talking about heart attacks, then if certain measures are followed, it is possible to prevent the occurrence of arrhythmias, which are oftenwith inadequate therapy, they end in a fatal outcome.
Of course, we must not forget that a lot depends on the patient himself. After all, the origins of all critical, life-threatening conditions originate from everyday life. These are malnutrition and bad habits, lack of sleep and an inactive lifestyle. It is these factors that are responsible for most cases of stroke and myocardial infarction.
