这篇综述集中在心脏手术中的氧化应激和更具体的脂质过氧化,围手术期并发症的基本理论之一。我们介绍了导致脂质过氧化的分子途径,并整合了分析方法,这些方法可以检测液相中的脂质过氧化标记物,而这些标记物侧重于呼出气中的挥发性化合物。为了探索文献中积累的数据,我们对丙二醛的定量分析进行了系统的综述,在心脏手术的各个阶段广泛使用的脂质过氧化产物。这一探索揭示了现有研究在报告值的可变性和手术期间由于离散和可变的采样时间而导致的显著差距方面的主要局限性。我们还评估了允许实时和连续监测氧化应激的方法。补充技术强调,除了心肺转流技术和心肌再灌注损伤的广受好评的贡献,透热疗法的使用对术中脂质过氧化有显著影响。我们得出的结论是,迫切需要在临床实践中实施氧化应激理论,以改变范式。首先,我们需要通过就最佳分析方法达成国际共识,在协调的多中心研究中产生定性和定量可比数据集,从而获得关于脂质过氧化和术后并发症之间联系的明确和无可辩驳的信息.其次,我们应该从常规的低风险手术转向更高风险的干预措施,因为在改善患者旅程和结局方面存在重大未满足的临床需求.还需要就最佳治疗干预措施达成共识,这些干预措施可以在令人信服的大规模临床试验中进行测试。作为未来的方向,我们提出了液相平台和“元数据”的组合,一种扩展形式的二氧化碳描记术-包括实时分析脂质过氧化和代谢的挥发性足迹-用于在高风险手术之前和期间更好地进行患者表型分析,以进行分子预测,患者旅程的分层和监测。
This review focuses on oxidative stress and more specifically lipid peroxidation in cardiac surgery, one of the fundamental theories of perioperative complications. We present the molecular pathways leading to lipid peroxidation and integrate analytical methods that allow detection of lipid peroxidation markers in the fluid phase with those focusing on volatile compounds in exhaled breath. In order to explore the accumulated data in the literature, we present a systematic review of quantitative analysis of malondialdehyde, a widely used lipid peroxidation product at various stages of cardiac surgery. This exploration reveals major limitations of existing studies in terms of variability of reported values and significant gaps due to discrete and variable sampling times during surgery. We also appraise methodologies that allow real-time and continuous monitoring of oxidative stress. Complimentary techniques highlight that beyond the widely acclaimed contribution of the cardiopulmonary bypass technology and myocardial reperfusion injury, the use of diathermy contributes significantly to intraoperative lipid peroxidation. We conclude that there is an urgent need to implement the theory of oxidative stress towards a paradigm change in the clinical practice. Firstly, we need to acquire definite and irrefutable information on the link between lipid peroxidation and post-operative complications by building international
consensus on best analytical approaches towards generating qualitatively and quantitatively comparable datasets in coordinated multicentre studies. Secondly, we should move away from routine low-risk surgeries towards higher risk interventions where there is major unmet clinical need for improving patient journey and outcomes. There is also need for
consensus on best therapeutic interventions which could be tested in convincing large scale clinical trials. As future directions, we propose combination of fluid phase platforms and \'metabography\', an extended form of capnography-including real-time analysis of lipid peroxidation and volatile footprints of metabolism-for better patient phenotyping prior to and during high risk surgery towards molecular prediction, stratification and monitoring of the patient\'s journey.