器官前處置在胸腔醫學方面的理論基礎與應用

肺部缺血與再灌注傷的臨床上扮演著重要的角色，相關機轉在過去文獻已有不少的探討。器官前處置(organ preconditioning, PC)是一個古老的觀念，但其機轉隨著生物科技的進展近年業才開始有深入而熱絡的研究。最早將其由過去生物體存在的現象導入細胞組織的就是心肌細胞的研究，在缺血心肌的觀察中有重大的發現。之後在骨骼肌、肝中都發現這種前處置效應的存在，近來在腦組織及肺中也逐步開始進行相關的研究、而其生物機轉，從細紀膜接受器（如adenosine receptor）到粒線體的離子通道（如K-ATP channel）都開始有了許多新奇的發現，這種發現甚至可以從急性疾病推展到一些慢性疾病的的模式。目前急待發現在肺中這種前處置機轉是否存在，前處置程度及特性如何影響從續的傷抵抗性，以及其分子機轉為何？透過動物體的研究，相信其成果不但可作為未來人類相關實驗的起步，而未來的應用也必廣泛、深入及不可限量。在本文中這一觀念在肺部的研究與應用，以及未來的展望作－概要性的描述。
Lung ischemia-reperfusion injury, also known as acute respiratory distress syndrome, is a common problem in medical practice that has a high mortality rate. The causes and treatment of this often dangerous complication has been studied previously. Recent developments in biotechnology have refocused our attention on organ preconditioning. Although the concept, which dates back more than one thousand years ago, is not new, recent developments in biotechnology have shed more light on the topic. Preconditioning is defined as precedent sub-lethal injuries caused by ischemia, hyper-or hypothermia, or pharmacological agents can protect the organs or tissues from hyper-or hypothermia, or pharmacological agents can protect the organs or tissues from muscle, liver, neurons and lung. Many related signal transduction pathways, from cell membrane receptors (e.g. adenosine receptor) to ion channel in mitochondria (K-ATP channel), have been found to be related to the organ preconditioning. These pathways can even be extrapolated from acute to chronic diseases model. Herein we review previous literature about the existence of preconditioning in the lung and literature discussing the relationship between the degrees of preconditioning and the resistance to subsequent injuries.