Окислительный стресс в кардиохирургии

Ischemia, reperfusion, oxidative stress, system inflammatory response – all these events are the cause or important link in the pathogenesis of numerous serious complications of cardiac surgeries. The damaging action of each of the above has been numerously proved by experiments and clinical practice and it seems that these events can be considered to be only very negative ones. However controlled ischemia initiates development of the phenomenon so-called as ischemic pre-conditioning, when the targeted organ develops enhanced resistance to the consequent damaging ischemia. Reperfusion is an inevitable and necessary stage of rehabilitation after previous ischemia. What about oxidative stress? Damaging potential of the active forms of oxygen is a fact, however minimal concentrations of the active oxygen forms are intercellular regulators and it means they are absolutely necessary for normal cellular vital activity. Besides numerous studies have proved noticeable intensification of the oxidative stress during artificial circulation (AC), however stuides failed to demonstrate reduction in the number of complications and peri-operative mortality when performing coronary artery bypass on the beating heart compared to the surgeries performed under AC. What is the true contribution of the oxidative stress into the development of post-operative complications? There have been found no evidences of the clinical efficiency of any of existing antioxidants as per mortality reduction criteria or decrease of hospital stay duration. Unfortunately we do not have unambiguous answers to the set up questions. There is no doubt only about the fact that critical actuality dictates the urgent need for further studying of the oxidative stress role in the pathogenesis of ischemic and reprefusional lesions in cardiac surgery.